Isle of Wight County Virginia USGenWeb Archives Vitals.....Uzzell, E. Everett, 1919 

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Emmett Everett "Buddy" UZZELL, d. 5 Jun 1911 - 11 Jun 1919, death certificate 

[Official Form (printed); handwritten responses <thus>] 

______________________________________________________________________________ 

[header] 
Form No. 12.[?]               Certificate of Death 
1.      Place Of Death      Commonwealth of Virginia 
County Of <Isle of Wight>  Bureau of Vital Statistics       16528 [stamped] 
District of [blank]          State Board of Health 
    Or                               ____ 
Inc. Town of [blank] 
    Or                   Registration District No. <462>   Registered No. <6> 
City of [blank]          (No. [blank]    St.          [blank]    Ward) 

2. Full Name <Emmett Everett Uzzle> 
   (A) Residence  [blank] 
______________________________________________________________________________ 

[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)  <single> 
 5A. If Married, Widowed, or Divorced, 
     Husband of (or) Wife of <[check mark]> 
 6. Date of Birth <June 5-> 19<11> 
 7. Age     <8> Years [blank] Months <9> Days 

 8. Occupation 
  (a) Trade, profession, or particular kind of work [blank] 
  (b) General nature of industry, [...] [blank] 

 9. Birthplace  <Va> 
                <Isle of Wight> 

Parents 
10. Name of Father <Geter E. Uzzle> [Jeter Everett Uzzell] 
11. Birthplace of Father <Va> 
12. Maiden Name of Mother <Lula Munford> 
13. Birthplace of Mother <Va> 

14. The above is true to the best of my knowledge. 
    (Informant) <Geter * Uzzle> 
      (Address) <Windsor Va> 

15. Filed <July 9>, 19<19>   <Mrs. L.S.[?] Deans> 
                                      Local Registrar. 

______________________________________________________________________________ 


[column 2 of 2] 
          Medical Certificate of Death 
16. Date of Death <June 11>, 19<19> 
17.   I Hereby Certify, That I attended deceased from 
    <June 6>, 19<19>  to  <June 11>, 19<19> 
    that I last saw h<im> alive on <June 11>, 19<19> 
    and that death occurred, on the date stated above, at <11 P>M. 
    The Cause of Death* was follows: 
      <Cerebra Spinal Meningitis> 
                              Duration  [blank] Yrs. [blank] Mos. <6> Ds. 
    Contributory [blank] 
                              Duration  [blank] 

18. Where was disease contracted if not at place of death? <[check mark]> 
    Did an operation precede death? <no>  Date of <[check mark]> 
    Was there an autopsy? <no> 
    What test confirmed diagnosis? <none> 

         (Signed) <T. G. Bradshaw>, M.D. 
    [date blank]   (Address) <Windsor Va> 


19. Place of Burial, Cremation or Removal      Date of Burial 
    <Antioch>                                 <June 13[?]>, 19<19> 
20. Undertaker                                 Address 
    <C.[?]W. Bailey>                          <Windsor Va> 


______________________________________________________________________________ 
[document end] 

The Library of Virginia 
Bureau Of Vital Statistics, Death Certificate 16528 

Contributed for use in USGenWeb Archives by: 
Matt Harris, Zoobug64@aol.com (Apr 2010) [brackets, line breaks mine], 
from photograph graciously provided by Ann Marie Piland.