Vital Records: Silas SLIGH, 1921, Bedford Co., VA Contributed for use in USGenWeb Archives by: Matt Harris, Zoobug64@aol.com (Jan 2008) [brackets, line breaks mine] *********************************************************** Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm *********************************************************** Bedford County Virginia USGenWeb Archives Vital Records Silas SLIGH, d. 30 Jan 1921, death certificate [Official Form (printed); handwritten responses ] [margin instructions illegible in microfilm image] [header] Form No. 12 1. Place Of Death Certificate of Death File No.--For County Of Commonwealth of Virginia State Registrar Only Magisterial Bureau of Vital Statistics <265 over> District of State Board of Health Or [small check mark] ____ Inc. Town of Registration District No. <97D> Registered No. <1> Or (To Be Inserted By Registrar)-(For Use of Local Registrar) City of [blank] (No. [blank] St.; [blank] Ward) (If death occurred in a Hospital or Institution give its NAME instead of street and number) 2 Full Name Residence in City [blank] Yrs. [blank] Mos. [blank] Days ______________________________________________________________________________ [column 1 of 2] Personal and Statistical Particulars 3 Sex 4 Color or Race 5 Single, Married, Widowed, or Divorced (Write the word) 6 Date of Birth , 1<839> (Month) (Day) (Year) 7 Age <81> yrs. <1> mos. <-> ds. If LESS Than 1 Day, [blank] hrs. or [blank] min.? 8 Occupation (a) Trade, profession, or particular kind of work (b) General nature of Industry, business, or establishment in which employed (or employer) [blank] 9 Birthplace (State or Country) Parents 10 Name of Father 11 Birthplace of Father (State or country) 12 Maiden Name of Mother 13 Birthplace of Mother (State or country) 14 The Above is True to the Best of My Knowledge (Informant) (Address) 15 Filed , 19<21>. Local Registrar. ______________________________________________________________________________ [column 2 of 2] Medical Certificate of Death 16 Date of Birth[struck] Death[stamped] , 19<21> (Name of month) (Day) (Year) 17 I HERBY CERTIFY, That I attended deceased from , 19<20> to , 19<20> that I last saw h alive on , 19<20> and that death occurred on the date stated above, at <9.0 p.>m. The CAUSE OF DEATH* was as follows: [blank] [blank] (Duration) [blank] yrs. <9[struck]> mos. <15[struck]> ds. Contributory (Secondary) [blank] (Duration) [blank] yrs. <9> mos. <15> ds. (Signed) M.D. , 19<21> (Address) *State the DISEASE CAUSING DEATH, or, in deaths from VIOLENT CAUSES, state (1) MEANS OF INJURY; and (2) whether ACCIDENTAL, SUICIDAL or HOMICIDAL. ______________________________________________________________________________ 18 Length of Residence. (For Hospitals, Institutions, Transients, or recent Residents.) At place In the of death[blank]yrs.[blank]mos.[blank]ds. State[blank]yrs.[blank]mos.[blank]ds. Where was disease contracted, if not at place of death? [blank] Former or usual Residence [blank] ______________________________________________________________________________ 18. Place of Burial or Removal Date of Burial [?; Hunting Creek?] , 19<21> 19. Undertaker Address ______________________________________________________________________________ [page end] [overleaf] [column 1 of 2] Revised United States Standard Certificate of Death [bold] (Approved by U. S. Census and American Public Health Association) _______________ State of Occupation--Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespec- tive of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Loco- motive Engineer, Civil Engineer, Stationary Fire- man, etc. But in many cases, especially in industrial employment, it is necessary to know (a) the kind of work, also (b) the nature of the business or industry, and therefore an additional line is pro- vided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cot- ton Mill; (a) Salesman, (b) Grocery; (a) Foreman, (b) Automobile Factory. The material worked on may form part of the [illegible; document had been folded in quarters, and] turn "Laborer," "Foreman," [illegible; this quadrant badly soiled] etc., without more precise specifications, as Day La- borer, Farm Laborer, Laborer-Coal Mine, etc. Wo- men at home, who are engaged in [illegible] household only (not paid Housekeeping [illegible] a definite salary), may be entered as [illegible] Housework, or at Home, and children [illegible] employed, as At School, or At Home, [illegible] be taken to report specifically the occupations of persons engaged in domestic service for wages as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, state occupation at beginning of ill- ness. If retired from business, that fact may be in- dicated thus: Farmer (retired 6 yrs.). For persons who have no occupation whatever, write None. State of Cause of Death--Name first the DISEASE CAUSING DEATH (the primary affliction with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebro-spinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever (never report [column 2 of 2] "Typhoid pneumonia"); Lobar pneumonia; Broncho- pneumonia ("Pneumonia," unqualified is indefinite); Tuberculosis of lungs, meniges, peritoneum, etc., Carcinoma, Sarcoma, etc., of ........(name origin); "Cancer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or inter- current) affection need not be stated unless import- ant. Example: Measles (disease causing death), 29ds.; Bronchopneumonia (secondary) 10ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart Failure," "Hemorrhage," "In- anition," "Maramus," "Old Age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be as- certained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUER- PERAL septicemia, "PUERPERAL peritonic," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS state MEANS OF INJURY and qual- ify as ACCIDENTAL, SUICIDAL or HOMICIDAL or as prob- ably such, if impossible to determine definitely. Ex- amples: Accidental drowning; struck by railway train-accident; Revolver wound of head-homicide; Poisoned by carbolic acid-probably suicide. The nature of the injury, as fracture of the skull, and con- sequences (e. g., sepsis, tetanus) may be stated un- der the head of "Contributory." [Named occupations and diseases above italicized] NOTE Certificates will be returned for additional inform- ation which give any of the following diseases, without explanation, as the sole cause of death: Abortion, cellutis, childbirth, convulsions, hemor- rhage, gangrene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis, pyemia, septicemia, tetanus. A stillbirth must be registered both as a birth and death. The date of death should be the date of delivery, and the death certificate should further state, if known, the cause of the stillbirth and the period of uterine gestation in months. [inverted, in respect to regulations above] [document end] The Library of Virginia, Richmond, VA Bureau Of Vital Statistics, Death Certificates, 1912-1939 (Accession 36390) Death Certificate 559-265, Microfilm Reel 98 [HOWELL, JONES, SLIGH, SLOUGH, SLY]