Southampton County Virginia USGenWeb Archives Vitals.....Clark, Mattie, 1916 

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Mattie CLARKE, 
     13 Jul 1916 - 20 Jul 1916, 
     death certificate abstract 

______________________________________________________________________________ 

Certificate of Death, Vol. 262, No. 18774 
Commonwealth of Virginia 
Bureau of Vital Statistics {BVS} 
State Board of Health 
Form No. 12. 

Place Of Death: County of Southampton; 
                District of Boykins 
Registration District No. 871c 
Registered No. 32 

Full Name: Mattie Clark 
______________________________________________________________________________ 

Personal and Statistical Particulars 

Sex: Girl 
Color or Race: White 
Marital Status: Single 

Date of Birth: July 13, 1916 
Age: 7 ds. 

Occupation: [blank] 

Birthplace: Va ["Henry Clark" struck]  

Father: 
-Name: Henry Clark* 
-Birthplace: Va 

Mother: 
-Maiden Name: Florence Conwell* 
-Birthplace: Va 

Informant: Henry Clark 
             Branchville 

Burial or Removal: Person Church*, July 21, 1916  
Undertaker: Harris Darden Co. 
             Branchville 

Filed: July 20, 1916 
Registrar: John Z. Harris 
______________________________________________________________________________ 

Medical Certificate of Death 
Date of Death: July 20, 1916 

I Hereby Certify, 
That I attended deceased from 
[blank] to [blank] 
I last h__ alive on [blank] 
Death is said to have occurred, on date stated above, at _____ _.m. 

The Cause of Death was as follows: 
   Born too early 
Duration: [blank] 

Contributory (Secondary): [blank] 

[not signed by doctor] 
______________________________________________________________________________ 

The Library of Virginia, Richmond, VA 
Bureau Of Vital Statistics, Death Certificate 1916-262-18774 


*Additional information: 

Buried in Person's Methodist Church Cemetery, near Adams Grove, as is her 
   paternal grandmother.  Cemetery list originally gave Mar 1919 - Oct 1919. 
   Southampton County Historical Society {SCHS} Cemetery Project, 
   Miscellaneous Cemeteries, Vol. 3 (III-51): 
   http://files.usgwarchives.net/va/southampton/cemeteries/miscvol3.txt 

Her parents (surname spelled CLARKE) are buried Beechwood Cemetery, Boykins- 
   Annex 2, Plot 156. 
   SCHS Cemetery Project, Beechwood: 
   http://files.usgwarchives.net/va/southampton/cemeteries/beechwd.txt 

Mattie's parents' marriage is not found in Southampton Co. records. 


Contributed for use in USGenWeb Archives by: 
Matt Harris, zoobug64@aol.com (Dec 2013) [brackets mine] 

file size: 4 Kb 

file at: 
http://files.usgwarchives.net/va/southampton/vitals/deaths/c462m1dc.txt