Benton Co., AR - Vitals - William Robert Rose

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Arkansas State Department of Health
Bureau of Vital Statistics
Registration District No. 5
Certificate of Death
Cetificate Number 141
1.  Place of Death
County:  Benton
City:  Bentonville (inside city limits)
Hospital:  Bates memorial Hospital
2.  Usual Residence
State:  Arkansas
County:  Benton
City:  Bentonville (inside city limits)
Street Address:  402 N. W. 3rd
3.  Name of Deceased:  William Robert Rose
4.  Date of Death:  9-12-70 (1970), 3:15 AM
5.  Sex:  M
6.  Color or Race:  W
7.  Social Security Number:  430-18-5521-A
8.  Date of Birth:  2-18-92 (1892)
9.  Age:  78
10.  Occupation:  Retired Butcher
11.  Birthplace:  Bentonville, Ark.
12.  Citizen:  USA
13.  Married
14:  Surviving Spouse:  Effie Webb
15.  Father:  Philander Rose
16.  Mother-Maiden Name:  Caroline Davis
17.  Informant:  Bill Dalton
        Fayettevile, Ark.
18.  Cause:  Coronary Thrombosis (5 ?)
        Due to Coronary Sclerosis (5 years)
        4159
        No autopsy
21.  Physician attended from 9-9-70 to 9-12-70
        Last seen alive:  9-11-70
        Death Occurred 3:15 AM
23.  Signature:  John A Rollow MD
        Date Signed:  9-17-70
        City:  Bentonville, Ark 72712
24.  Burial
        Burial:  Bentonville Cemetery, Bentonville, Ark.
        Date:  9-14-70
25.  Funeral Director:  Callison-McKinney FH, Bentonville, Ark
26.  Embalmer:  J. E. Bounds, Iicense no. 1273
27.  Date Rec'd by local Reg.:  9-18-70
28.  Registrar's Signature:  Norma Kay Gill