Death Certificate of Percy H. Drake

Percy H. Drake, age 60, died of coronary occlusion on 2 Jun 1943 in
Franklin, Southampton County, Virginia. He was born 22 Mar 1883 to Geo.
W. Drake and Martha Elizabeth Johnson. He was married to Lessie Fowler
Drake. His usual residence was Norfleet St., Franklin, Virginia.

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| Field                                                  | Value                         |
|--------------------------------------------------------|-------------------------------|
| 1. (a) County                                          | Southampton                   |
| 1. (b) Magisterial district                            | Franklin                      |
| 1. (c) City or town                                    | [Not filled]                  |
| 1. (d) Name of hospital or institution                 | [Not filled]                  |
| 1. (e) Length of stay in hosp. or inst.                | [Not filled]                  |
| 1. (f) (Specify whether years, months, or days)        | [Not filled]                  |
| 1. (g) Place of death within corporate limits?         | Yes                           |
| 1. (h) If place of death within corporate limits?      | [Not filled]                  |
| 2. (a) State                                           | Virginia                      |
| 2. (b) County                                          | Southampton                   |
| 2. (c) City or town                                    | Franklin                      |
| 2. (d) Street                                          | Norfleet St.                  |
| 2. (e) Is place of residence within corporate limits?  | Yes                           |
| 2. (f) Citizen of foreign country?                     | No                            |
| 2. (g) If Yes, name country                            | [Not filled]                  |
| 3. FULL NAME                                           | Percy H. Drake                |
| 3. (b) VETERAN                                         | No                            |
| 4. Sex                                                 | Male                          |
| 5. Color or race                                       | White                         |
| 6. (a) Single, married, widowed, divorced              | Married                       |
| 6. (b) Name of husband or wife                         | Lessie Fowler Drake           |
| 7. Date of birth of deceased                           | March 22, 1883                |
| 8. Age at death                                        | 60 years, 2 months, 11 days   |
| 9. Birthplace (City, town, or county)                  |                               |
| 9. (State or foreign country)                          |                               |
| 10. Usual occupation                                   | Retired Clerk                 |
| 11. INDUSTRY OR BUSINESS?                              |                               |
| 12. Name of father                                     | Geo. W. Drake                 |
| 13. Birthplace of father                               | Va.                           |
| 14. Maiden name of mother                              | Martha Elizabeth Johnson      |
| 15. Birthplace of mother                               | Va.                           |
| 16. Informant’s name                                   | Geo. H. Drake                 |
| 16. Address                                            | Franklin, Va.                 |
| 17. Burial, cremation, or removal                      | Burial                        |
| 17. Place                                              | Franklin, Va.                 |
| 17. Date                                               | June 4, 1943                  |
| 18. Undertaker                                         | Wm. Holland & Son             |
| 18. Address                                            | Franklin, Va.                 |
| 19. Filed                                              | June 5, 1943, Wm. H. Duck     |
| 20. Date of death                                      | June 3, 1943, 7:40 PM         |
| 21. I hereby certify                                   | June 2, 1943                  |
| 21. to                                                 | June 3, 1943                  |
| 21. That I last saw him alive on                       | June 3, 1943                  |
| 21. Immediate cause of death                           | Coronary occlusion            |
| 21. Duration                                           | Sudden                        |
| 21. Due to                                             | [Blank]                       |
| 21. Other conditions                                   | 094A                          |
| 22. Name of operation                                  | [Blank]                       |
| 22. Date of operation                                  | [Blank]                       |
| 22. Major findings (if of operations)                  | [Blank]                       |
| 22. (b) of autopsy                                     | [Blank]                       |
| 23. Accident, suicide, or homicide (specify)           | [Blank]                       |
| 23. Date of occurrence                                 | [Blank]                       |
| 23. Where did injury occur?                            | [Blank]                       |
| 23. (County)                                           | [Blank]                       |
| 23. (State)                                            | [Blank]                       |
| 23. Where did injjury occur?                           | [Blank]                       |
| 23. While at work?                                     | [Blank]                       |
| 23. Means of injury (Specify type of place)            | [Blank]                       |
| 23. Signature                                          | J.C. Rawls, M.D.              |
| 23. Address                                            | [Blank]                       |
| 23. Date signed                                        | [Blank]                       |
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