Isle of Wight County Virginia USGenWeb Archives Vitals.....Carr, Martha S. Darden, 1929 

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Martha Sarah (DARDEN; Mrs. John T.) CARR, 
     12 Jun 1861 - 29 Oct 1929, death certificate 

[Official Form (printed); handwritten responses <thus>] 
 Form V. S. No. 12--2-25-29. 
______________________________________________________________________________ 

[header] 
                              Certificate of Death 
   1.  Place Of Death       Commonwealth of Virginia 
County Of <Isle of Wight>  Bureau of Vital Statistics       26918 [stamped] 
District of <Windsor>        State Board of Health 
    Or                               ____ 
Inc. Town of [blank] 
    Or                   Registration District No. <462C>  Registered No. <12> 
City of [blank]          (No. [blank]    St.          [blank]    Ward) 

2. Full Name <Martha Sarah Carr> 
   (A) Residence.  No.  [blank]     St.     [blank]    Ward     [blank] 
         (Usual place of abode)   (If non-resident give city or town and State) 
______________________________________________________________________________ 
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[column 1 of 2] 
          Personal and Statistical Particulars 
______________________________________________________________________________ 
 3. Sex <Female>  4. Color or Race <White> 
 5. Single, Married, Widowed, or Divorced (write the word)  <Married> 
 5A. If Married, Widowed, or Divorced, 
     Husband of (or) Wife of <John T. Carr>
 6. Date of Birth <June 12, 1861> 
 7. Age    <68> Years [blank] Months [blank] Days 
Occupation 
 8. Trade, profession, or particular 
    kind of work done, as Spinner, 
    sawyer, bookkeeper, etc. <Housewife> 
 9. Industry or business in which 
    work was done, as silk mill, saw 
    mill, bank, etc. [blank] 
10. Date deceased last worked at      11. Total Time (Years) 
    this occupation (month and            Spent in this 
    year) [blank]                         Occupation [blank] 
______________________________________________________________________________ 
12. Birthplace  (city or town) <Isle of Wight Co> 
             (State or country) [blank] 
______________________________________________________________________________ 
Father 
13. Name <David Darden> 
14. Birthplace (city or town) [blank] 
             (State or country) [blank] 
Mother 
15. Maiden Name <Polley Darden> 
16. Birthplace (city or town) [blank] 
             (State or country) [blank] 
______________________________________________________________________________ 
17. Informant <Georgie Carr> 
    (Address)  [blank] 
______________________________________________________________________________ 
18. Burial, Cremation or Removal 
    Place <Burial>            Date <Oct 30>, 1<929>  
______________________________________________________________________________ 
19. Undertaker  <W J M Holland & Son> 
    Address [blank] 
______________________________________________________________________________ 
20. Filed <Oct 3  [sic]>, 1<929>   <J.O. Scott> 
                                              Registrar. 
______________________________________________________________________________ 
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[column 2 of 2] 
          Medical Certificate of Death 
______________________________________________________________________________ 
21. Date of Death 
        (month, day, and year) <Oct 29.th>, 1<929> 
______________________________________________________________________________ 
22.     I Hereby Certify, That I Attended Deceased From 
    <Mch_ >, 1<926>  To  <Oct_21.st>, 1<929> 
    That I Last Saw H<er> Alive On <Oct 21.st>, 1<929> 
    And That Death Occured, On Date Stated Above, At <4_30 A>M. 
    The Cause of Death* Was As Follows:                     Date of Onset 
      <Valvular heart disease>                              <1924> 
          <90> 

    Contributory Causes of Importance Not Related to 
    Principal Cause: [blank] 

    Name of operation <[check mark]>             Date of [blank] 
    What test confirmed diagnosis? <[check mark]> Was there an autopsy? [blank] 
______________________________________________________________________________ 
23. If Death was due to External Causes (Violence) Fill in Also the 
    Following: 
  Accident, Suicide, or Homicide <[check mark]> Date of Injury <[check mark]>, 1 
  Where did Injury Occur? <[check mark]> 
                         (Specify city or town, county, and State) 
Specify Whether Injury Occurred in Industry, in Home, or in Public 
    Place. <[check mark]> 
______________________________________________________________________________ 
  Manner of Injury <[check mark]> 
  Nature of Injury <[check mark]> 
______________________________________________________________________________ 
24. Was Disease or Injury in any way related to Occupation of 
    Deceased?  <no> 
  Is so, specify <[check mark]> 
       (Signed) <C J Bradshaw>, M.D. 
          (Address) <Carrsville Va> 
______________________________________________________________________________ 
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[document end] 

The Library of Virginia (LVA), Richmond, VA 
   Bureau Of Vital Statistics, Death Certificate 1077-26918 

Contributed for use in USGenWeb Archives by: 
Matt Harris (Zoobug64@aol.com) [brackets & capitalization mine]. 

file at: 
http://files.usgwarchives.net/va/isleofwight/vitals/deaths/c600m1dc.txt