North Carolina State Board Of Health
Bureau of Vital Statics

Standard Certificate Of Death

Place of Death: Caldwell Coutny, Granite Falls, NC

Full Name: Annie Rebecca Mayes
Residence: Granite Falls, NC

Personal And Statistical Particulars

Sex: Female Color or Race: White Single, Married, Widowed or Divorced: Widowed
Husband or Wife: C.F. Mayes

Age: 66 Yrs 8 Months 14 Days

Trade, profession or particular kind of work: Housekeeper
Birthplace N Carolina
Name of Father: Jordan Payne
Birthplace of Father: N Carolina
Maiden Name of Mother: Mary L Payne
Birthplace of Mother: N Carolina

Informant: Rondal Mayes
Address: Granite Falls, NC

Burial, Cremation, or Removal
Place: Mt Zion Date: 2-14-1936
Filed: Mar 6 1936 Undertaker: Ethel Wakefield

Medical Certificate Of Death

Date of Death 2-11-1936
No Medical Aid
Patient found dead in bed

Signed: C.R. Russell, MD
Address: Granite Falls, NC