Isle of Wight-Southampton County Virginia USGenWeb Archives Vitals.....Uzzell, Gustavious T., 1916 

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Gustavious T. Uzzell, 20 Aug 1860 - 5 Feb 1916, death certificate 

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

______________________________________________________________________________ 

[header] 
Form No. 12.[?]               Certificate of Death          File No.- 
1.      Place Of Death      Commonwealth of Virginia   For State Registrar Only 
County Of <Isle of Wight>  Bureau of Vital Statistics        4130 [stamped] 
District of <Hardy>          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 <Agustavious Uzzell>     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)  <Widowed> 
 6. Date of Birth <Aug  20th 1860> 
 7. Age     <56> Years <6> Months <15> Days 

 8. Occupation 
  (a) Trade, profession, or particular kind of work <Retired> 
  (b) General nature of industry, [...] <Saloon Keeper> 
 9. Birthplace <Southampton County Va> 

Parents 
10. Name of Father <William H. Uzzell> 
11. Birthplace of Father <do not know> 
12. Maiden Name of Mother <Emmeline Howell> 
13. Birthplace of Mother <Southampton Co Va> 

14. The above is true to the best of my knowledge. 
    (Informant) <J. F. Uzzell> 
      (Address) <Suffolk Va> 

15. Filed <Feby 8>, 191<6>   <W. R. Hall[?]> 
                                      Local Registrar. 

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[column 2 of 2] 
          Medical Certificate of Death 
16. Date of Death <Feb 5>, 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: 
      <Brights Disease> 
      <according to J F Uzzle> 
                              Duration  [blank] 
    Contributory <D    K   > 
                              Duration  [blank] 

         (Signed) <[illegible]>, M.D. 
    2/6, 191<6>   (Address) <Smithfield Va> 

18. Length of Residence [blank] 

19. Place of Burial or Removal      Date of Burial 
    <Newport News Va>               <Feb 8th>, 191<6> 
20. Undertaker                      Address 
    <G.E. Rouse>                    <Newport News Va> 


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[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.