Isle of Wight County Virginia USGenWeb Archives Vitals.....Johnson, Jesse T., 1928 

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Jesse Thomas "Jett" JOHNSON (Jr.), 13 Feb 1888 - 9 Sep 1928, death certificate 

[Official Form (printed); handwritten responses <thus>] 
Form No. 12. 
______________________________________________________________________________ 

[header] 
                              Certificate of Death 
1.  Place Of Death          Commonwealth of Virginia 
County Of <Isle of Wight>  Bureau of Vital Statistics       20976 [stamped] 
District of <Hardy>          State Board of Health 
    Or                               ____ 
Inc. Town of [blank] 
    Or                  Registration District No. <460a>  Registered No. [blank] 
City of [blank]          (No. [blank]    St.          [blank]    Ward) 

2. Full Name <Jesse T. Johnson> 
   (A) Residence.  No.  [blank]     St.     [blank]    Ward     [blank] 
         (Usual place of abode)   (If non-resident give city or town and State) 
______________________________________________________________________________ 
ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ 

[column 1 of 2] 
          Personal and Statistical Particulars 
______________________________________________________________________________ 
 3. Sex <Male>  4. Color or Race <White> 
 5. Single, Married, Widowed, or Divorced (write the word)  [blank] 
           <[all but "Single" struck]> 
 5A. If Married, Widowed, or Divorced, 
     Husband of (or) Wife of [blank] 
 6. Date of Birth <Feb 13th   1888> 19[struck; form too specific]
 7. Age    <40> Years <6> Months <26> Days 
 8. Occupation of Deceased 
  (a) Trade, profession, or particular kind of work <Farmer> 
  (b) General nature of industry, 
  business, or establishment in 
  which employed (or employer) [blank] 
  (c) Name of employer [blank] 
______________________________________________________________________________ 
 9. Birthplace 
    (City or Town) <Isle of Wight Co> 
    (State or Country)         <Va> 
______________________________________________________________________________ 
Parents 
10. Name of Father <Tommy Johnson> 
11. Birthplace of Father 
    (City or Town) [blank] 
    (State or Country) <Va> 
12. Maiden Name of Mother <Mollie Horne> 
13. Birthplace of Mother 
    (City or Town) [blank] 
    (State or Country) <Va> 
______________________________________________________________________________ 
14. Informant <J. Richard Johnson> 
    (Address)     <Zuni  Va.> 
______________________________________________________________________________ 
15. Filed <Sept 10>, 19<28>   <W.C.[?] Andrews> 
                                      Registrar 
______________________________________________________________________________ 
ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ 

[column 2 of 2] 
          Medical Certificate of Death 
______________________________________________________________________________ 
16. Date of Death <September 9> 19<28> 
17.        I Hereby Certify, That I Attended Deceased From 
    [blank], 19[blank]  To  [blank], 19[blank] 
            <Dead When I Arrived> 
    That I Last Saw H[blank] Alive On [blank], 19[blank] 
    And That Death Occured, On Date Stated Above, At <8 P.>M. 
    The Cause of Death* Was As Follows: 
      <Chronic Myocarditis> 
       <Died suddenly while> 
       <driving car> 
                       <90> 
                              Duration  [blank] Yrs. [blank] Mos. [blank] Ds. 
    Contributory <Obesity> 
      (Secondary)             Duration  [blank] Yrs. [blank] Mos. [blank] Ds. 

18. Where was disease contracted if not at place of death? [blank] 
    Did an operation precede death? <no>  Date of [blank] 
    Was there an autopsy? <no> 
    What test confirmed diagnosis? [blank] 

         (Signed) <W D Tillson[?]>, M.D. 
    <Sept 13>, 19<28>  (Address) <Windsor> 
    *State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, 
         state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCI- 
         DENTAL, SUICIDAL, or HOMICIDAL. 

______________________________________________________________________________ 

19. Place of Burial, Cremation or Removal      Date of Burial 
    <At home>                                  <9/11-28> 
20. Undertaker  <C.W. Bailey> 
    Address <Windsor  Va> 
______________________________________________________________________________ 
ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ 
[document end] 


The Library of Virginia (LVA), Richmond, VA 
   Bureau Of Vital Statistics, Death Certificate 1002-20976 

Additional information: 

James Thomas Johnson was his father's correct name, but most people called him 
   Jesse Thomas Johnson (that's why son Jesse Thomas Johnson is sometimes 
   called Jesse Jr.). 

"Uncle Jett" (Jesse Thomas Johnson) was moved from the home place to Antioch 
   Sept 2009 along with: 
   his father James Thomas Johnson (15 Apr 1859 - 21 Aug 1920) "Jesse" 
   his mother Mary Elizabeth Horne Johnson (26 May1859 - 11 Mar 1955) "Molly" 
   and an unkown person that was also in the family cemetery. 
   They are buried along the road near the driveway that goes back to the old 
   Bridger home along the strawberry patch. {Anne Marie Piland} 

Jett's obituary ("Virginian-Pilot," Sep. 11, 1928, p. 15, col. 7-8) posted at 
   http://files.usgwarchives.net/va/isleofwight/obits/j525j13o.txt 


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/j525j1dc.txt