Death Certificate of c, Willard

Willard Drake, age 73, died of cerebral thrombosis due to
arteriosclerosis on 29 Nov 61 at Veterans Administration Hospital,
Kecoughtan, Virginia. He was born 8 Jun 1888 in Southampton, Va., to
William H. [Drake] and Fannie Vick. He was widowed, spouse Fannie Vick,
and lived at 78 West Virginia Ave., Phoebus, Virginia.

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| Field                                         | Value                                              |
|-----------------------------------------------|----------------------------------------------------|
| REGISTRATION AREA NUMBER                      | 211                                                |
| CERTIFICATE NUMBER                            | 789                                                |
| STATE FILE NUMBER                             | 27617                                              |
| 1. FULL NAME OF DECEASED                      | WILLARD DRAKE                                      |
| 2. SEX                                        | male [X]                                           |
| 3. DATE OF DEATH                              | Nov. 29 61                                         |
| 4. AGE OF DECEASED                            | 73 years                                           |
| 5. COLOR OR RACE                              | White [X]                                          |
| 6. NAME OF HOSPITAL OR INSTITUTION            | Veterans Administration Hospital                   |
| 7. CITY OR TOWN                               | Hampton                                            |
| 8. COUNTY OF DEATH                            | Virginia                                           |
| 9. USUAL RESIDENCE OF DECEDENT                | 78 West Virginia Ave.                              |
| 10. CITY OR TOWN                              | Phoebus                                            |
| 11. COUNTY OF RESIDENCE                       | Virginia                                           |
| 12. STATE                                     | Va.                                                |
| 13. NAME OF FATHER                            | William H.                                         |
| 14. NAME OF MOTHER                            | Fannie Vick                                        |
| 15. WAS DECEDENT EVER IN U.S. ARMED FORCES?   | U. S. A. [X]                                       |
| 16. VETERAN OF                                | World War I (ONE)                                  |
| 17. MARITAL STATUS                            | Widowed [X]                                        |
| 18. NAME OF SPOUSE                            |                                                    |
| 19. USUAL OCCUPATION                          | Farmer                                             |
| 20. KIND OF BUSINESS OR INDUSTRY              | U.S. Government Records                            |
| 21. BIRTHPLACE (State or country)             | South-Hampton[southampton], Va.                    |
| 22. DATE OF BIRTH                             | June 8, 1888                                       |
| 23. IMMEDIATE CAUSE (A)                       | Cerebral thrombosis                                |
| 24. DUE TO (B)                                | Arteriosclerosis                                   |
| 25. OTHER SIGNIFICANT CONDITIONS              | Arteriosclerotic heart disease: Diabetes mellitus: |
| 26. INTERVAL BETWEEN ONSET AND DEATH          | 6 Days                                             |
| 27. AUTOPSY                                   | No [ ]                                             |
| 28. IF DEATH WAS DUE TO EXTERNAL CAUSE        | (not filled)                                       |
| 29. SIGNATURE OF PHYSICIAN                    | Wm. Stamps                                         |
| 30. DATE SIGNED                               | 12-4-61                                            |
| 31. PLACE OF DEATH OCCURRED                   | Kecoughtan, Virginia                               |
| 32. FUNERAL DIRECTOR                          | R. Hayden Smith Funeral Home                       |
| 33. PLACE OF BURIAL OR REMOVAL                | Hampton National Cemetery, Hampton, Virginia       |
| 34. DATE OF BURIAL OR REMOVAL                 | 12-4-61                                            |
| 35. REGISTRAR                                 | Grace Franklin Deputy                              |
| 36. DATE RECEIVED BY REGISTRAR                | 12-4-61                                            |
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