Death Certificate of Drake, Willie N

Willie N. Drake, 52, died of uremic poison and chronic nephritis on 18
Jan 1934 in Newsoms, Southampton County, Virginia. He was a armer.
married to Rosa Drake and born in Southampton County to George Drake and
Mary Johnson.  Burial took place at his home place near Newsoms on 19
Jan 1934.

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| Field                                        | Value                                |
|----------------------------------------------|--------------------------------------|
| 1. PLACE OF DEATH COUNTY OF                  | Southampton                          |
| 1. PLACE OF DEATH MAGISTERIAL DISTRICT OR    | Monroe                               |
| REGISTRATION DISTRICT NO.                    | 872                                  |
| REGISTERED NO.                               | 2829                                 |
| Length of residence:                         | 52 yrs.                              |
| How long in U.S., if of foreign birth        | 52 yrs.                              |
| (A) RESIDENCE                                | Va.                                  |
| 3. SEX                                       | Male                                 |
| 4. COLOR OR RACE                             | White                                |
| 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED     | Married                              |
| 6. SPOUSE:                                   | Rosa Drake                           |
| 7. AGE                                       | 52 Years                             |
| 8. TRADE, PROFESSION, ETC?                   | Farmer                               |
| 9. INDUSTRY OR BUSINESS?                     | Farming                              |
| 10. LAST WORKED:                             |                                      |
| 11. TIME IN OCCUPATION?                      |                                      |
| 12. BIRTHPLACE (city or county)              | Southampton Co.                      |
| 13. NAME OF FATHER                           | George Drake                         |
| 14. BIRTHPLACE OF FATHER (city or county)    | Southampton Co.                      |
| 15. MAIDEN NAME OF MOTHER                    | Mary Johnson                         |
| 16. BIRTHPLACE OF MOTHER (city or county)    | Va.                                  |
| 17. INFORMANT                                | Mr. Porter                           |
| 17. INFORMANT ADDRESS                        | Newsoms                              |
| 18. BURIAL, CREMATION, OR REMOVAL PLACE      | his home place                       |
| 18. BURIAL, CREMATION, OR REMOVAL DATE       | Jan 19, 1934                         |
| 18. UNDERTAKER                               | W. M. Holland & Son                  |
| 18. UNDERTAKER ADDRESS                       | (Not listed)                         |
| 20. FILED                                    | 1/19 1934                            |
| 20. REGISTRAR                                | Sidney Bryant                        |
| 21. DATE OF DEATH                            | Jan 18, 1934                         |
| 22. I ATTENDED DECEASED FROM                 | Jan 15, 1934 TO Jan 18, 1934         |
| 22. I LAST SAW HIM ALIVE ON                  | Jan 18, 1934                         |
| 22. DEATH OCCURRED AT                        | 3:30 P.M.                            |
| 22. PRINCIPAL CAUSE OF DEATH                 | uremic poison and chronic nephritis  |
| 22. Date of onset                            |                                      |
| 22. Contributory causes                      |                                      |
| 23. IF DEATH WAS DUE TO                      | (blank)                              |
| 23. DATE OF ACCIDENT, SUICIDE, OR HOMICIDE   | (blank)                              |
| 23. WHERE DID INJURY OCCUR?                  | (blank)                              |
| Industry, home, or public place?             | (blank)                              |
| 23. MANNER OF INJURY                         | (blank)                              |
| 23. NATURE OF INJURY                         | (blank)                              |
| 24. OCCUPATION RELATED??                     | No                                   |
| (SIGNED)                                     | B. A. Pope, M.D.                     |
| (ADDRESS)                                    | Newsoms, Va.                         |
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