Death Certificate for Amanda Clifton Hines
(C. Avis Catalog entry #1429)
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WEST VIRGINIA STATE DEPARTMENT OF HEALH - DIVISION OF VITAL STATISTICS
CERTIFICATE OF DEATH
Serial No. 97 61 015398
Name of Deceased: Amanda Evelyn Hines
Date of Death: Nov. 5, 1961
Place of Death: Marshall County, Glen Dale, Glen Dale Hospital; inside city limits
Usual Residence: 206 Parriott Ave., Moundeville, Marshall Co., W. Va.
Inside city limits; not a farm
Female, White, Widowed
Date of birth: Mar., 25, 1884
Age: 77 years 7 months 10 days
Occupation: Housewife
Birthplace: West Virginia
Father: John Clifton
Mother: Jane Baldwin
Informant: Mrs. D. S. Oura Moundeville
Cause of death: Double pneumonia - 2 Edema of lungs
Due to: Bed patient at rest home
Interval between onset and death: 3 or 4
Other conditions: none
Autopsy: No
Accident: Bruised both legs & hips from falls
Place of injury: Rest home Cameron, Marshall Co., W. Va.
I attended deceased from Nov 3, 1961 to 11/5, 1961 and last saw the deceased alive on 11/5, 1961.
Death occurred at Reynolds Memorial Hospital at 2:00 pm on the date stated above, and to the best of my knowledge, from the causes stated.
Signature: R. A. Ashworth M. D. 906 - 3rd St. Moundeville, W.Va Signed: 11-6.61
Burial, Cremation, Removal: Removal
Date: 11/5/61
Cemetery: Mt. Moriah, Smithfield, Penn
Funeral Director: L. R. Lutes [signed]
Dated Rec'd by Local Registrar: November 5, 1961
Registrar's signature: Mary L. McCombs
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Death record of Amanda Clifton Hines - 1961
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