Isle of Wight County Virginia USGenWeb Archives Vitals.....Joyner, Jethro T., 1929 

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Jethro Thomas JOYNER, 18 Mar 1855 - 25 Nov 1929, 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       26921 [stamped] 
District of <Hardy>          State Board of Health 
    Or                               ____ 
Inc. Town of [blank] 
    Or                   Registration District No. <460A>  Registered No. <9> 
City of [blank]          (No. [blank]    St.          [blank]    Ward) 

2. Full Name <Jethro Thomas Joyner> 
   (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 <Male>  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 <Josephine Daughtry> 
 6. Date of Birth <March 18   1855> 19<[struck; form too specific]> 
 7. Age    <74> Years [blank] Months [blank] Days 
 8. Occupation of Deceased 
  (a) Trade, profession, or particular kind of work <Farming> 
  (b) General nature of industry, 
  business, or establishment in 
  which employed (or employer) [blank] 
  (c) Name of employer [blank] 
______________________________________________________________________________ 
 9. Birthplace 
    (City or Town) <Va> 
    (State or Country) [blank] 
______________________________________________________________________________ 
Parents 
10. Name of Father <Jethro Joyner> 
11. Birthplace of Father 
    (City or Town) <Va> 
    (State or Country) [blank] 
12. Maiden Name of Mother <Mary Jane Vaughan> 
13. Birthplace of Mother 
    (City or Town) <Va> 
    (State or Country) [blank] 
______________________________________________________________________________ 
14. Informant <N.J. Joyner> 
    (Address)  <Zuni> 
______________________________________________________________________________ 
15. Filed <Nov 25>, 19<29>   <W.C.[?] Andrews> 
                                      Registrar 
______________________________________________________________________________ 
ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ 

[column 2 of 2] 
          Medical Certificate of Death 
______________________________________________________________________________ 
16. Date of Death <November 25> 19<29> 
17.        I Hereby Certify, That I Attended Deceased From 
    <Nov 21>, 19<29>  To  <Nov 25>, 19<29> 
    That I Last Saw H<im> Alive On <Nov 25>, 19<29> 
    And That Death Occured, On Date Stated Above, At <4.45 P>M. 
    The Cause of Death* Was As Follows: 
      <Apoplexy _> 
                  <129> 
                              Duration  [blank] Yrs. [blank] Mos. <7> Ds. 
    Contributory <Chronis Nephritis> 
      (Secondary)             Duration  [blank] Yrs. [blank] Mos. [blank] Ds. 

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

         (Signed) <Wm D Tillson[?]>, M.D. 
    <Nov 26>, 19<29>  (Address) <Windsor Va> 
    *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 
    <Antioch>                                 <11- 27> 
20. Undertaker  <C. W. Bailey> 
    Address <Windsor Va.> 

______________________________________________________________________________ 
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[document end] 

The Library of Virginia (LVA), Richmond, VA 
   Bureau Of Vital Statistics, Death Certificate 1077-26921 

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

Tombstone photo available from contributor. 

Cemetery listing at: 
http://www.iwchs.com/Documents/Antioch%20Church_Antioch%20Rd_Cemetery.doc 

file at: 
http://files.usgwarchives.net/va/isleofwight/vitals/deaths/j560j1dc.txt