Death Certificate of Chisman Drake

The infant Chisman Drake, 0, died on 14 Nov 1930 in Southampton from 
lymphosarcoma. A resident of Courtland, Va, he was never married and 
was buried on 14 Nov 1928 at near Franklin, Va.

Chisman Drake was born 14 Nov 1928 Southampton County, Virginia, to 
Loronzo Drake and Lona Turner. He was buried on 14 Nov 1928 near 
Franklin, Va. 

|--------------------------------------------------------------------------------|
| Field                                   | Value                                |
|-----------------------------------------|--------------------------------------|
| 1. County                               | Southampton                          |
| 1. Magisterial District                 | Jerusalem                            |
| 1. Inc. Town                            | Courtland                            |
| 2. FULL NAME                            | Chisman Drake                        |
| a. RESIDENCE                            | Courtland, Va                        |
| Length of residence:                    | 0                                    |
| 3. SEX                                  | Male                                 |
| 4. COLOR OR RACE                        | White                                |
| 5. Single, Married, Widowed or Divorced | Single                               |
| 5a. SPOUSE:                             |                                      |
| 6. DATE OF BIRTH                        | Nov 13, 1930                         |
| 7. AGE                                  | 0                                    |
| 8. Occupation of Deceased               |                                      |
| 9. Birthplace                           | Southampton Co., Va                  |
| 10. Name of Father                      | Loronzo Drake                        |
| 11. Birthplace of Father                | Va                                   |
| 12. Maiden Name of Mother               | Lona Turner                          |
| 13. Birthplace of Mother                | Southampton Co., Va                  |
| 14. Informant                           | Loronzo Drake                        |
| 15.                                     | Franklin, Va                         |
| Filed                                   | 11/14, 1928                          |
| 16. Date of Death                       | Nov 14, 1930                         |
| 17. Attendance Dates                    | Nov 13, 1930 to Nov 14, 1930         |
| 17. Last saw alive                      | Nov 13, 1930                         |
| 17. Death occurred                      | 1 p.m.                               |
| Cause of Death                          | Lymphosarcoma                        |
|--                                       | 0 (years)                            |
| Contributory                            | None                                 |
| 18. Where disease contracted            | -                                    |
| Operation preceded death                | No                                   |
| Was there an autopsy?                   | No                                   |
| What test confirmed diagnosis?          |                                      |
| (Address)                               | Courtland, Va                        |
| SIGNED                                  | [illegible] M.D.                     |
| Place of Burial, Cremation, or Removal  | near Franklin                        |
| Date of Burial                          | 11/14/28                             |
| Undertaker                              | W/ J. M. Holland                     |
| Address                                 | Franklin , Va                        |
| Registration District No.               | 873B                                 |
| Registered No.                          | 29833                                |
|--------------------------------------------------------------------------------|

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