Margaret J. PAYTON (Virt) Death Certificate

TEXAS DEPARTMENT OF HEALTH

BUREAU OF VITAL STATISTICS

STATE OF TEXAS

CERTIFICATE OF DEATH

STATE FILE NO.: 16602

1. PLACE OF DEATH

a. COUNTY: Cameron

b. CITY OR TOWN: Rural Precinct #3

c. LENGTH OF STAY: 4 mos.

d. FULL NAME OF HOSPITAL OR INSTITUTION: Home - old San Benito Highway

2. USUAL RESIDENCE

a. STATE: Texas

b. COUNTY: Cameron

c. CITY OR TOWN: Rural Precinct #3, San Benito, Texas

d. STREET ADDRESS: Route 4, Box 13

3. NAME OF DECEASED: Maggie Mannan

4. DATE OF DEATH: April 26, 1950

5. SEX: female

6. COLOR OR RACE: white

7. MARRIED...: widowed

8. DATE OF BIRTH: April 25, 1859

9. AGE: 91 years, 0 months, 1 day

10a. USUAL OCCUPATION: housewife

10b. KIND OF BUSINESS OR INDUSTRY: [blank]

11. BIRTHPLACE: Indiana

12. FATHER'S NAME: Leroy Peyton

BIRTHPLACE: Indiana

13. MOTHER'S MAIDEN NAME: Mary Denny

BIRTHPLACE: Indiana

14. WAS DECEASED EVER IN U.S. ARMED FORCES? no

15. SOCIAL SECURITY NO.: none

16. INFORMANT'S SIGNATURE: Mrs. J. S. Beare

17. CAUSE OF DEATH:

I. DISEASE OR CONDITION DIRECTLY LEADING TO DEATH:

(a): Cerebral hemorrhage

INTERVAL BETWEEN ONSET AND DEATH: 6 hours

ANTECEDENT CAUSES: DUE TO: Arterio sclerosis

INTERVAL BETWEEN ONSET AND DEATH:

II. OTHER SIGNIFICANT CONDITIONS: advanced age

18a. DATE OF OPERATION: none

18b. MAJOR FINDINGS OF OPERATION: [blank]

19. AUTOPSY? No.

20a. ACCIDENT...: [blank]

20b. PLACE OF INJURY: [blank]

20c. CITY...: [blank]

20d. TIME OF INJURY: [blank]

20e. INJURY OCCURRED: [blanks]

20f. HOW DID INJURY OCCUR? [blank]

21. I hereby certify that I attended the deceased from Jan 11, 1950, to Apr 26, 1950, that I last saw the deceased alive on Apr 26, 1950, and that death occurred at 4:30 a.m., from the causes and on the date stated above.

22a. SIGNATURE: Alfred M. Litzerich, M.D.

22b. ADDRESS: 914-17 McKilney [?] Bldg., Harlingen, Texas

22c. DATE SIGNED: Apr 27, 1950

23a. BURIAL, CREMATION, REMOVAL: removal

23b. DATE: April 28, 1950

23c. NAME OF CEMETERY OR CREMATORY: Paragon Cemetery

23d. LOCATION: Paragon, Indiana

24. FUNERAL DIRECTOR'S SIGNATURE: Kreidler-Ashcraft Funeral Home

25a. REGISTRAR'S FILE NO.: 17

25b. DATE REC'D BY LOCAL REGISTRAR: 4-28-50

25c. REGISTRAR'S SIGNATURE: Blanche Longland