Death Certificate of Etheldred Warren Beale, Sr

Etheldred Warren Beale, Sr., 76, died on 30 Apr 1997 in Southampton
Memorial Hospital from CVA (cast bleed). A resident of Courtland, he was
married to Dorothy G. Beale and was buried on 5 May 1997 at Poplar
Spring Cemetery, Franklin, VA.

Mr. Beale was born on 12 Dec 1920, was white, and resided at 16411 Tvor
Road, Courtland, Virginia, outside city limits. He was owner and
vice-president of H.P. Beale & Sons, Inc. His parents were Hugh Patrick
Beale and Roberta Wellons.

|---------------------------------------------|----------------------------------------------------|
| Field                                       | Value                                              |
|---------------------------------------------|----------------------------------------------------|
| REGISTRATION AREA NUMBER                    | 233                                                |
| CERTIFICATE NUMBER                          | 68                                                 |
| STATE FILE NUMBER                           | 97-016834                                          |
| FULL NAME OF DECEDENT                       | Etheldred Warren Beale, Sr.                        |
| DATE OF DEATH                               | APR. 30, 1997                                      |
| AGE                                         | 76                                                 |
| IF UNDER 1 YEAR                             | ________ (days) ________                           |
| IF UNDER 1 DAY                              | ________ (minutes) ________                        |
| DATE OF BIRTH                               | DEC. 12, 1920                                      |
| SEX                                         | Male                                               |
| VETERAN OF U.S. ARMED FORCES                | YES ( ) NO                                         |
| 1. NAME OF PLACE OF DEATH                   | Southampton Memorial Hospital                      |
|--                                           | 1000 Fairview Drive                                |
| 2. COUNTY OR INDEPENDENT CITY, BEGAN LIVING | Franklin                                           |
| 3. STATE OR FOREIGN COUNTRY                 | Virginia                                           |
| 4. RESIDENCE: COUNTY                        | Southampton                                        |
| 5. ADDRESS                                  | 16411 Tvor Road                                    |
| 6. RESIDENCE: CITY/TOWN                     | Courtland Yes (X) No                               |
| 7. ZIP CODE                                 | 23837                                              |
| 8. NAME OF DECEDENT'S FATHER                | Hugh Patrick Beale                                 |
| 9. MAIDEN NAME OF DECEDENT'S MOTHER         | Roberta Wellons                                    |
| 10. RACE OF DECEDENT                        | white                                              |
| 11. BIRTHPLACE                              | U.S.A.                                             |
| 12. EDUCATION                               | 11 + 2 Collrdge                                    |
| 13. USUAL OCCUPATION                        | Owner & Vice-President                             |
| 14. KIND OF BUSINESS OR INDUSTRY            | H.P. Beale & Sons, Inc.                            |
| 15. SOCIAL SECURITY NUMBER                  | [Redacted]                                         |
| 16. MARITAL STATUS                          | Never Married ( ) Divorced (X) Married ( ) Widowed |
| 17. NAME OF SURVIVING SPOUSE                | Dorothy G. Beale                                   |
| 18. INFORMANT - NAME & RELATIONSHIP         | son - E. Warren Beale, Jr                          |
| 19. INFORMANT - ADDRESS                     | [Not filled]                                       |
| IMMEDIATE CAUSE                             | CVA (Cast bleed)                                   |
| INTERVAL BETWEEN ONSET AND DEATH            | -                                                  |
| PART II. OTHER SIGNIFICANT CONDITIONS       | [Blank]                                            |
| Autopsy                                     | YES  | (X) NO                                      |
| 29b. AUTOPSY AUTHORIZED BY                  | ______                                             |
| DATE PRONOUNCED DEAD                        | 4/30                                               |
| ATTENDING PHYSICIAN                         | O.L. Goodman                                       |
| DATE SIGNED                                 | 5/2/97                                             |
| ADDRESS OF ATTENDING PHYSICIAN              | Franklin, VA                                       |
| FUNERAL DIRECTOR                            | Alan Edwards                                       |
| PLACE OF DISPOSITION                        | Poplar Spring Cemetery                             |
| CITY OR COUNTY                              | Franklin, VA                                       |
| REMOVAL                                     | Burial ( ) Cremation ( ) Removal (X) Other         |
| NAME OF FUNERAL HOME                        | Wright Funeral Home                                |
| ADDRESS                                     | 206 W. 4th Ave., Franklin, VA                      |
| NAME OF EMBALMER                            | William B. Wright                                  |
| REGISTRAR                                   | Evelyn C. Payne                                    |
| DATE RECEIVED                               | 5-5-97                                             |
|---------------------------------------------|----------------------------------------------------|

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