Vital Records: Henry F. SLY, 1930, Staunton, VA Contributed for use in USGenWeb Archives by: Matt Harris, Zoobug64@aol.com (Jan 2008) [brackets, line breaks mine] *********************************************************** Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm *********************************************************** Augusta County Virginia USGenWeb Archives Vital Records Henry F. SLY, d. 25 Aug 1930, death certificate [Official Form (printed); handwritten responses ] [margin notes] Form No. 12 Margin Reserved for Binding N. B.=Write Plainly, With Unfading Ink (Writing Fluid)-This is a Permanent Record. Every Item of Information Should Be Carefully Supplied. Age Should BE Stated EXACTLY. PHYSICIANS Should State the CAUSE OF DEATH In Plain Terms, So That It May Be Properly Classified. Exact Statement Of OCCUPATION is Very Important. ______________________________________________________________________________ [header] 1 Place Of Death Certificate of Death County Of [blank] Commonwealth of Virginia [stamped] 20617 Magisterial Department of Health District of [blank] Bureau of Vital Statistics Or Inc. Town of [blank] Registration District No. <2070> Registered No. <241> Or (To Be Inserted By Registrar)-(For Use of Local Registrar) City of (No. [blank], St. Ward) (If death occurred in a hospital or other institution, give its NAME instead of street and number) 2 Full Name (A) Residence. No. [blank] St., [blank] Ward (Usual place of abode) (If non-resident give city or town and State) Length of residence in city or town where death occurred <-> yrs. <-> mos. <12> ds. How long in U.S., if of foreign birth? [blank] yrs. [blank] mos. [blank] ds. ______________________________________________________________________________ [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[struck] 6 Date of Birth (month, day, and year) 19[struck] 7 Age Years <88> Months <5> Days <1> If LESS Than 1 Day, [blank] Hrs. or [blank] Min. 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) [small check mark on blank] (C) Name of Employer [small check mark on blank] 9 Birthplace (city or town) (State or country) Parents 10 Name of Father 11 Birthplace of Father (city or town) <"> (State or country) <"> 12 Maiden Name of Mother <"> 13 Birthplace of Mother (city or town) <"> (State or country) <"> 14 Informant (Address) 15 Filed , 19<30> Registrar. ______________________________________________________________________________ [column 2 of 2] Medical Certificate of Death 16 Date of Death (Month, Day, and Year. Write Name of Month) , 19<30> 17 I HERBY CERTIFY, That I Attended Deceased From , 19<30>, To , 19<30> That I Last Saw H Alive on , 19<30> And That Death Occurred, on Date Stated Above, at <8:20 a.>M. The Cause of Death* Was As Follows: [blank] <90>[penciled] [blank] Duration yrs. [blank] mos. [blank] ds. Contributory (Secondary) [blank] Duration yrs. [blank] mos. [blank] ds. 18 Where Was Disease Contracted If Not at Place of Death? Did an Operation Precede Death? Date of [small check mark on blank] Was There an Autopsy? What Test Confirmed Diagnosis? [small check mark on blank] (Signed) , M.D. , 19<30> (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 [Western State Hospital] Address ______________________________________________________________________________ [document end] The Library of Virginia Bureau Of Vital Statistics, Death Certificates, 1912-1939 (Accession 36390) Death Certificate 1127-20617, Microfilm Reel 194 [BVS Death Index gives "Sly, Harry F."] [FREED, SLIGH, SLOUGH, SLY]