Isle of Wight-Southampton County Virginia USGenWeb Archives Vitals.....Uzzell, George W., 1928 

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George Washington UZZELL, 30** Oct 1855 - 2 Sep 1928, 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       20977 [stamped] 
District of <Hardy>          State Board of Health 
    Or                               ____ 
Inc. Town of [blank] 
    Or                   Registration District No. <460a>  Registered No. <7> 
City of [blank]          (No. [blank]    St.          [blank]    Ward) 

2. Full Name <George Washington Uzzell> 
   (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)  <Widowed> 
 5A. If Married, Widowed, or Divorced, 
     Husband of (or) Wife of <Jennie V. Uzzell> 
 6. Date of Birth <Oct. 30**   1855> 19[blank; form too specific] 
 7. Age    <72> Years <10> Months [blank] Days 
 8. Occupation of Deceased 
  (a) Trade, profession, or particular kind of work <Farmer> 
  (b) General nature of industry, 
  business, or establishment in 
  which employed (or employer) [blank] 
  (c) Name of employer [blank] 
______________________________________________________________________________ 
 9. Birthplace 
    (City or Town) <Southampton Co, Va> 
    (State or Country) [blank] 
______________________________________________________________________________ 
Parents 
10. Name of Father <William Uzzell> 
11. Birthplace of Father 
    (City or Town) <[check mark]   X> 
    (State or Country) <Virginia> 
12. Maiden Name of Mother <Unknown> 
13. Birthplace of Mother 
    (City or Town)           <X> 
    (State or Country)    <Va>
______________________________________________________________________________ 
14. Informant <John P. Uzzell> 
    (Address)  <Zuni  Va.> 
______________________________________________________________________________ 
15. Filed <Sept 3>, 19<28>   <W.C.[?] Andrews> 
                                      Registrar 
______________________________________________________________________________ 
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[column 2 of 2] 
          Medical Certificate of Death 
______________________________________________________________________________ 
16. Date of Death <September 2> 19<28> 
17.        I Hereby Certify, That I Attended Deceased From 
    [blank], 19[blank]  To  [blank], 19[blank] 
            <Dead When I Arrived> 
    That I Last Saw H[blank] Alive On [blank], 19[blank] 
    And That Death Occured, On Date Stated Above, At <9_50 A>M. 
    The Cause of Death* Was As Follows: 
      <Apoplexy_> 
                      <74a> 
                              Duration  [blank] Yrs. [blank] Mos. [blank] Ds. 
    Contributory <Senility> 
      (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? <History> 

         (Signed) <W D Tillson[?]>, M.D. 
    <Sept 3>, 19<28>  (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 Church>                           <Sept 4/28> 
20. Undertaker  <R.W. Baker> 
    Address <Suffolk  Va_> 


______________________________________________________________________________ 
[document end] 

The Library of Virginia (LVA), Richmond, VA 
   Bureau Of Vital Statistics, Death Certificate 1002-20977 

[George's parents were William H. UZZELL Sr. 1m. 1849 (Southampton) 
 Margaret J. "Peggy" COUNCIL. {Wm 2m. 1864/5 (IoW) Texanna VAUGHN.} 
 **BVS Old Birth Index gives b. 29 Oct 1855 (IoW, p. 14). 
 
 Difficult to say why birth was registered in Isle of Wight; as far as I know, 
 the family did not move to IoW until after 1860: 
 (3 Aug) 1860 Census- Southampton Co., VA, E side of Nottoway R., p. 30, 
 dwelling #236, family #229, lines 13-21, all in household b. Southampton Co., VA 
 W.H. UZZELL, 37M, Farmer, $350 personal estate; 
 M. UZZELL, 37F; W.H. UZZELL, 10M; J.T. UZZELL, 9M; John F. UZZELL, 8M; 
 M.E. UZZELL, 6F; G. UZZELL, 4M; S. UZZELL, 3F; J. UZZELL, 1M.] 

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

file at: 
http://files.usgwarchives.net/va/isleofwight/vitals/deaths/u240g2dc.txt