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NORTH CAROLINA STATE BOARD OF
HEALTH CERTIFICATE OF DEATH
GROVER WILLIAMS
Date: 17 December 1963
Cert: 36982
Place of Death: County: Buncombe
Township: Leicester
Length of stay (in this place): 18 months
City or Town: Leicester
Street address or location: Route 2
Usual Residence of Deceased: State: North Carolina
County: Buncombe City or Town:
Leicester
Street Address: Route 2
Full Name: Grover WILLIAMS
Date of Death: 17 December 1963
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: 04 April 1916
Age: 47 years
Usual Occupation: Miner
Kind of Industry or business: Coal Mine
Birthplace: Knott County, Ky.
Father's Name: John H. WILLIAMS
Mother's Maiden Name: Susan SLOAN
Name of Husband or Wife: Louise FIELDS WILLIAMS
Was deceased ever in armed forces: No
Social Security No.: (blank)
Informant: Sidney WILLIAMS, Hindman, Ky.
Death was caused by: Gunshot wound chest, heart, liver,
pancreas with (illegible)
Interval between onset and death: Sudden
Due to (b): (blank)
Other significant conditions: (blank)
Autopsy: yes
Accident, suicide, or homicide: Homicide
Describe how injury occurred: Shot allegedly by his wife with
22 Rifle
Time of injury: 17 December 1963 5:29 a.m.
Injury occurred at work: Not while at work
Place of Injury: at home above
County/State: Buncombe, N.C.
I attended deceased from never to
(blank), that I last saw him alive on (blank). Death occurred at
5:29 a.m., on the date stated above; and to the best of my
knowledge from the causes stated.
Signature: (illegible), Coroner
Address: Asheville, N.C.
Date signed: 18 December 1963
Burial, Cremation or Removal: Removal
Date: 18 December 1963
Name of Cemetery or Crematory: Williams Cemetery
Location: Pine Top, Ky.
Date received by local registrar: 18 December 1963
Registrar's Signature: G. W. Stevens
Funeral director & address: Groce Funeral Home,
Inc., 1401 Patton Ave., Asheville, N.C.
Transcribed by Debbie Tamborski, 14 August 2010 |
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