Isle of Wight-Southampton County Virginia USGenWeb Archives Vitals.....Uzzell, Gustavious T., 1916 ************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/va/vafiles.htm ************************************************ Gustavious T. Uzzell, 20 Aug 1860 - 5 Feb 1916, death certificate [Official Form (printed); handwritten responses ] ______________________________________________________________________________ [header] Form No. 12.[?] Certificate of Death File No.- 1. Place Of Death Commonwealth of Virginia For State Registrar Only County Of Bureau of Vital Statistics 4130 [stamped] District of State Board of Health Or ____ Inc. Town of [blank] Registered No. <4 Four> Or Registration District No. <460 D> (For Use of Local Registrar) City of [blank] (No. [blank] St. [blank] Ward) 2. Full Name Residence [blank] ______________________________________________________________________________ [column 1 of 2] Personal and Statistical Particulars 3. Sex 4. Color or Race 5. Single, Married, Widowed, or Divorced (write the word) 6. Date of Birth 7. Age <56> Years <6> Months <15> Days 8. Occupation (a) Trade, profession, or particular kind of work (b) General nature of industry, [...] 9. Birthplace Parents 10. Name of Father 11. Birthplace of Father 12. Maiden Name of Mother 13. Birthplace of Mother 14. The above is true to the best of my knowledge. (Informant) (Address) 15. Filed , 191<6> Local Registrar. ______________________________________________________________________________ [column 2 of 2] Medical Certificate of Death 16. Date of Death , 191<6> 17. I Hereby Certify, That I attended deceased from [blank] to [blank] that I last saw h[blank] alive on [blank] and that death occurred, on the date stated above, at <8 a[?]>m. The Cause of Death was follows: Duration [blank] Contributory Duration [blank] (Signed) <[illegible]>, M.D. 2/6, 191<6> (Address) 18. Length of Residence [blank] 19. Place of Burial or Removal Date of Burial , 191<6> 20. Undertaker Address ______________________________________________________________________________ [document end] The Library of Virginia Bureau Of Vital Statistics, Death Certificate 4130 photographed by Ann Marie Piland 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.