Death Certificate of Drake, Rosa Alice

Rosa Alice Drake, age 71, died of bronchial pneumonia due to pulmonary
thrombosis on 19 Feb 1956 at her residence in Newsoms, Southampton
County, Virginia. Born 10 Sep 1884 in Southampton County, Virginia to
William H. Drake and Fannie Vick, she was widowed, spouse William Norman
Drake, and resided at R.F.D. #1, Newsoms.

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| Field                                          | Value                       |
|------------------------------------------------|-----------------------------|
| 1. COUNTY                                      | Southampton                 |
| B. MAGISTERIAL DISTRICT                        | Newsoms                     |
| C. CITY OR TOWN                                | Newsoms                     |
| D. HOSPITAL OR INSTITUTION                     | at residence                |
| E. LENGTH OF STAY                              | (blank)                     |
| 2. A. STATE                                    | Virginia                    |
| 2. B. COUNTY                                   | Southampton                 |
| 2. C. CITY OR TOWN                             | Newsoms                     |
| 2. D. ADDRESS                                  | R.F.D. #1                   |
| IS RESIDENCE ON A FARM?                        | NO (box checked)            |
| NAME OF DECEASED                               | Rosa Alice Drake            |
| SEX                                            | Female                      |
| COLOR OR RACE                                  | White                       |
| MARITAL STATUS                                 | Widowed                     |
| DATE OF BIRTH                                  | Sept. 10, 1884              |
| AGE                                            | 71 Years                    |
| USUAL OCCUPATION                               | Housewife                   |
| KIND OF BUSINESS OR INDUSTRY                   | At home                     |
| BIRTHPLACE                                     | Southampton Co., Virginia   |
| CITIZEN OF WHAT COUNTRY                        | U.S.A.                      |
| FATHER'S NAME                                  | William H. Drake            |
| MOTHER'S MAIDEN NAME                           | Fannie Vick                 |
| NAME OF HUSBAND OR WIFE OF DECEASED            | William Norman Drake        |
| INFORMANT'S SIGNATURE                          | Mrs. Willie Stoty           |
| INFORMANT'S ADDRESS                            | Boykins, Virginia           |
| 18. CAUSE OF DEATH                             | Bronchial Pneumonia         |
| 18. CAUSE OF DEATH                             | Pulmonary Thrombosis        |
| 18. CAUSE OF DEATH                             | Cardiac (illegible, .002)   |
| INTERVAL BETWEEN ONSET AND DEATH               | (blank)                     |
| 18. PART II. OTHER SIGNIFICANT CONDITIONS      | (blank)                     |
| 19. WAS AUTOPSY PERFORMED?                     | NO (box checked)            |
| 20. DESCRIBE HOW INJURY OCCURRED               | (blank)                     |
| 21. ATTENDED THE DECEASED FROM                 | 1950 to Feb. 19, 1956       |
| AND LAST SAW HER ALIVE ON                      | Feb. 19, 1956               |
| DEATH OCCURRED AT                              | 9 a.m.                      |
| 22. SIGNATURE                                  | J.M. Bland, M.D.            |
| 22A. ADDRESS                                   | Boykins, Va.                |
| 22B. DATE SIGNED                               | 2-20-56                     |
| 23A. BURIAL, CREMATION, REMOVAL (Specify)      | Burial                      |
| 23B. DATE                                      | Feb. 21, 1956               |
| 23C. NAME OF CEMETERY OR CREMATORY             | Newsoms Cemetery            |
| 23D. LOCATION (City, town, or county, State)   | Newsoms, Virginia           |
| DATE RECD. BY LOCAL REGISTRAR                  | March 4, 1956               |
| REGISTRAR'S SIGNATURE                          | Mrs. Leroy Dail             |
| 24. FUNERAL DIRECTOR'S SIGNATURE               | H. M. Purviance             |
| 24. ADDRESS                                    | Boykins, Virginia           |
| Registration No.                               | 872                         |
| Registered No.                                 | 4                           |
| Certificate No.                                | 5076                        |
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