Isle of Wight-Southampton County Virginia USGenWeb Archives Vitals.....Uzzell, Eva D., 1929 ************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/va/vafiles.htm ************************************************ Eva Della UZZELL, 18 Aug 1901 - 26 Nov 1929, death certificate [Official Form (printed); handwritten responses ] Form No. 12. ______________________________________________________________________________ [header] Certificate of Death 1. Place Of Death Commonwealth of Virginia County Of Bureau of Vital Statistics 26920 [stamped] District of State Board of Health Or ____ Inc. Town of [blank] Or Registration District No. <460A> Registered No. <8> City of [blank] (No. [blank] St. [blank] Ward) 2. Full Name (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 4. Color or Race 5. Single, Married, Widowed, or Divorced (write the word) 5A. If Married, Widowed, or Divorced, Husband of (or) Wife of <[check mark]> 6. Date of Birth 19<01> 7. Age <28> Years <3> Months [blank] Days 8. Occupation of Deceased (a) Trade, profession, or particular kind of work (b) General nature of industry, business, or establishment in which employed (or employer) [blank] (c) Name of employer [blank] ______________________________________________________________________________ 9. Birthplace (City or Town) (State or Country) [blank] ______________________________________________________________________________ Parents 10. Name of Father 11. Birthplace of Father (City or Town) (State or Country) [blank] 12. Maiden Name of Mother 13. Birthplace of Mother (City or Town) (State or Country) [blank] ______________________________________________________________________________ 14. Informant (Address) ______________________________________________________________________________ 15. Filed , 19<29> Registrar ______________________________________________________________________________ ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ [column 2 of 2] Medical Certificate of Death ______________________________________________________________________________ 16. Date of Death 19<29> 17. I Hereby Certify, That I Attended Deceased From , 19<29> To , 19<29> That I Last Saw H Alive On , 19<29> And That Death Occured, On Date Stated Above, At <12 >M. The Cause of Death* Was As Follows: <46> Duration [blank] Yrs. <5[struck] Mos. <5> Ds. Contributory [blank] (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? Date of Was there an autopsy? What test confirmed diagnosis? (Signed) , M.D. , 19<29> (Address) *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 20. Undertaker Address ______________________________________________________________________________ [document end] The Library of Virginia (LVA), Richmond, VA Bureau Of Vital Statistics, Death Certificate 1077-26920 Contributed for use in USGenWeb Archives by: Matt Harris (Zoobug64@aol.com) [brackets & capitalization mine]. donated obit at: http://files.usgwarchives.net/va/isleofwight/obits/u240e1ob.txt file at: http://files.usgwarchives.net/va/isleofwight/vitals/deaths/u240e3dc.txt