Southampton County Virginia USGenWeb Archives Vitals.....Holt, Hersey, 1923 ************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/va/vafiles.htm ************************************************ Hersey HOLT, 12 Apr 1922 - 13 Jul 1923, death certificate [Official Form (printed); handwritten responses ] Form No. 12. ______________________________________________________________________________ [header] Certificate of Death 1. Place Of Death Commonwealth of Virginia County Of Bureau of Vital Statistics 23516 [stamped] Magisterial State Board of Health District of ____ Or Inc. Town of Or Registration District No. <[blot] > Registered No. <3> City of [blank] (No. [blank], [blank] St.; [blank] Ward) 2. Full Name (A) Residence. [blank] St. [blank] Ward [blank] (Usual place of abode) (If non-resident give city or town and State) Length of residence in city or town where death occurred [blank] yrs [blank] mos. [blank] ds. How long in U.S., if of foreign birth [blank] yrs [blank] mos. [blank] ds. ______________________________________________________________________________ ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ [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 6. Date of Birth 19<22> 7. Age <1> Years <3> Months [blank] Days 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) [blank] (c) Name of employer [blank] ______________________________________________________________________________ 9. Birthplace (City or Town) (State or Country) [blank] ______________________________________________________________________________ Parents 10. Name of Father 11. Birthplace of Father (City or Town) (State or Country) [blank] 12. Maiden Name of Mother 13. Birthplace of Mother (City or Town) [blank] (State or Country) ______________________________________________________________________________ 14. Informant (Address) ______________________________________________________________________________ 15. Filed , 19<23.> Registrar ______________________________________________________________________________ ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ [column 2 of 2] Medical Certificate of Death ______________________________________________________________________________ 16. Date of Death 19<23> [date has been altered (overwritten)] 17. I Hereby Certify, That I Attended Deceased From , 19<23>, To , 19<23> That I Last Saw H[blank] Alive On , 19<23> And That Death Occured, On Date Stated Above, At <6 P>M. The Cause of Death* Was As Follows: <109B> Duration [blank] Yrs. [blank] Mos. <2> Ds. Contributory (Secondary) Duration [blank] Yrs. <6> Mos. [blank] Ds. 18. Where was disease contracted if not at place of death? <[check mark]> Did an operation precede death? Date of <[check mark]> Was there an autopsy? What test confirmed diagnosis? (Signed) M.D. [blank], 19[blank] (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 July 14, 19<23> 20. Undertaker Address ______________________________________________________________________________ ŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻŻ [document end] The Library of Virginia (LVA), Richmond, VA Bureau Of Vital Statistics, Death Certificate 712-23516 Additional information: My notes show Bill HOLT's wife as Maggie Green ADCOCK. Unmarked, but likely interred in the HOLT family cemetery, off Cottage Hill Rd. (Rt. 641). Southampton County Historical Society {SCHS} Cemetery Project, Miscellaneous Cemeteries, Vol. 7 (VII-16): http://files.usgwarchives.net/va/southampton/cemeteries/miscvol7.txt The (10 Apr) 1930 Census gives the following data: index 3-167 e.d. 88-3, sheet 8B, enumerator T. Philip RAIFORD Berlin Mill Road, 10 Apr 1930 dwelling 165/family 167, farm schedule #166, home owned 56. HOLT, William H., head, MW44, m. @27, able to read & write, speaks English, self & parents b. VA, Machinist- Bridge Building, Worker, not veteran 57. ---, Maggie, wife, FW36, m. @19[?], able to read & write, speaks English, self & parents b. NC, occupation- none 58. ---, Charles, son, MW16, single, able to read & write, speaks English, self & pa b. VA, ma b. NC, occupation- none, at'd school 59. ---, William H. Jr, son, MW14, single, able to read & write, speaks English, self & pa b. VA, ma b. NC, occupation- none, at'd school 60. ---, Douglas D., son, MW10, single, able to read & write, speaks English, self & pa b. VA, ma b. NC, occupation- none, at'd school 61. ---, Bryant F., son, MW 1& 10/12, single, self & pa b. VA, ma b. NC, occupation- none 62. LANKFORD, Bruce[?], lodger, MNeg32, single, self & parents b. VA, Laborer- Farm, not veteran 63. HOLT, Rickon, nephew, MW18, m. @18, able to read & write, speaks English, Laborer- Saw Mill 64. ---, Josie, niece, FW17, m. @17, able to read & write, speaks English, occupation- none. Contributed for use in USGenWeb Archives by: Matt Harris (Zoobug64@aol.com) [brackets & capitalization mine]. file at: http://files.usgwarchives.net/va/southampton/vitals/deaths/h430h1dc.txt