Southampton-Isle of Wight County Virginia USGenWeb Archives Vitals.....Mumford, Mary Lee, 1923 

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Mary Lee MUMFORD (MUNFORD), 8 Jan 1923 - 5 Sep 1923, death certificate 

[Official Form (printed); handwritten responses <thus>] 
Form No. 12. 
______________________________________________________________________________ 

[header] 
                              Certificate of Death 
1.  Place Of Death          Commonwealth of Virginia 
County Of  <Southampton>   Bureau of Vital Statistics        23539 [stamped] 
Magisterial                   State Board of Health 
District of <Franklin>                ____ 
    Or                     
Inc. Town of [blank] 
    Or                   Registration District No. <874>  Registered No. <40> 
City of [blank]          (No. [blank]    St.          [blank]    Ward) 

2. Full Name <Cathron Mumford> 
   (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 <Femail>  4. Color or Race <White> 
 5. Single, Married, Widowed, or Divorced (write the word)  <Single> 
 5A. If Married, Widowed, or Divorced, 
     Husband of (or) Wife of [blank] 
 6. Date of Birth <["Feb 7" struck] Jan 8> 19<23>
 7. Age    [blank] Years <7> Months <28> 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) <-> 
  (c) Name of employer [blank] 
______________________________________________________________________________ 
 9. Birthplace 
    (City or Town)       <Virginia> 
    (State or Country) [blank] 
______________________________________________________________________________ 
Parents 
10. Name of Father <E.E. Munford> 
11. Birthplace of Father 
    (City or Town)       <Virginia> 
    (State or Country) [blank] 
12. Maiden Name of Mother <Ruth Bradshaw> 
13. Birthplace of Mother 
    (City or Town)        <Virginia> 
    (State or Country) [blank] 
______________________________________________________________________________ 
14. Informant <E.E. Mumford> 
    (Address)     <Franklin Va> 
______________________________________________________________________________ 
15. Filed <Sept 13>, 19<23>   <C.C. Vaughan> 
                                      Registrar 
______________________________________________________________________________ 
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[column 2 of 2] 
          Medical Certificate of Death 
______________________________________________________________________________ 
16. Date of Death <Sept. 5> 19<23> [date has been altered (overwritten)] 
17.        I Hereby Certify, That I Attended Deceased From 
    <Aug 25>, 19<23>, To  <Sept 3rd>, 19<23> 
    That I Last Saw H<er> Alive On <Sept. 3rd>, 19<23> 
    And That Death Occured, On Date Stated Above, At <6 a>M. 
    The Cause of Death* Was As Follows: 
           <Malnutrition> 
               <160> 
                              Duration  [blank] Yrs.    <2>  Mos. [blank] Ds. 
    Contributory <Improper diet -> 
      (Secondary)             Duration  [blank] Yrs.    <3>  Mos. [blank] Ds. 

18. Where was disease contracted if not at place of death? <[check mark]> 
    Did an operation precede death? <no>  Date of <[check mark]> 
    Was there an autopsy? <no> 
    What test confirmed diagnosis? <none> 

         (Signed) <R L Raiford> M.D. 
    <9-5th>, 19<23>  (Address)    <Sedley 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 
    <Family Burying Grd>                       <9/6>  19<23> 
20. Undertaker  <W.J.M. Holland> 
    Address         <Franklin Va> 
______________________________________________________________________________ 
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[document end] 

The Library of Virginia (LVA), Richmond, VA 
   Bureau Of Vital Statistics, Death Certificate 712-23539 

[Her parents m. 4/20/1911 by C.H. ROWLAND (Southampton M.Reg., 1911, ln. 94); 
 Emmett E. MUNFORD, 23, b. Sout, farmer, sn/o Alex & B.; 
 Ruth E. BRADSHAW, 20, b. Sout, dt/o J.D. & M.J.
 
 Emmette (3/27/1887-5/23/1959) and Ruth (9/8/1890-2/7/1975) are buried at 
 Black Creek Baptist Church Cemetery. 

 Emmette's parents were Alexander W. MUNFORD (12/7/1855-11/18/1890) 
 m. 2/17/1881 (IoW) Elizabeth "Bettie" BROCK (1860-1931).
 
 Ruth's parents were Joel D. BRADSHAW (10/15/1845-1/31/1923) 
 m. 1/19/1888 Martha J. "Mattie" BEATON (b. circa 1862).] 

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/m516m1dc.txt