Death Certificate of Duck, Daniel Voyshes

Narrative summary of the form data:

Daniel Voyshes Duck, age 70, was born 17 Nov 1893 in Isle of Wight, VA,
to Mills H. Duck and Mary Johnson. He was widowed and resided at 1202
Pine Street, Hopewell, Prince George County, VA. He died 21 Jan 1964 at
Veterans Administration Hospital, Richmond, Chesterfield County, VA.
Cause of death was undifferentiated carcinoma of lung with left pleural
effusion. Spouse: Salo Duck.

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| Field Name (Prefix)                                 | Value                                                       |
|-----------------------------------------------------|-------------------------------------------------------------|
| REGISTRATION AREA NUMBER                            | 120-A                                                       |
| CERTIFICATE NUMBER                                  | 31                                                          |
| STATE FILE NUMBER                                   | 2104                                                        |
| 1. FULL NAME OF DECEASED                            | DANIEL VOYSHES DUCK                                         |
| 2. SEX                                              | MALE                                                        |
| 3. DATE OF DEATH                                    | JANUARY 21, 1964                                            |
| 4. AGE OF DECEASED                                  | 70                                                          |
| 5. IF UNDER 1 YEAR, MONTHS                          | [blank]                                                     |
| 6. IF UNDER 1 MONTH, DAYS                           | [blank]                                                     |
| 7. COLOR OR RACE                                    | WHITE                                                       |
| 8. NAME OF HOSPITAL OR INSTITUTION                  | VETERANS ADMINISTRATION HOSPITAL                            |
| 9. COUNTY OF DEATH                                  | CHESTERFIELD                                                |
| 10. CITY OR TOWN OF DEATH                           | RICHMOND                                                    |
| 11. STREET ADDRESS OF PLACE OF DEATH                | [blank]                                                     |
| 12. STATE OR FOREIGN COUNTRY OF DECEDENT'SRESIDENCE | VIRGINIA                                                    |
| 13. COUNTY OF DECEDENT'S RESIDENCE                  | PRINCE GEORGE                                               |
| 14. CITY OR TOWN OF RESIDENCE                       | HOPEWELL                                                    |
| 15. STREET ADDRESS OR RT. NO. OF RESIDENCE          | 1202 PINE STREET 213                                        |
| 16. NAME OF FATHER OF DECEASED                      | MILLS H. DUCK                                               |
| 17. MAIDEN NAME OF MOTHER OF DECEASED               | MARY JOHNSON                                                |
| 18. CITIZEN OF WHAT COUNTRY                         | U.S.A.                                                      |
| 19. MARITAL STATUS                                  | WIDOWED                                                     |
| 20. NAME OF SPOUSE                                  | EALO DUCK                                                   |
| 21. DATE OF BIRTH OF DECEASED                       | 11-17-93                                                    |
| 22. USUAL OR LAST OCCUPATION                        | RETIRED                                                     |
| 23. KIND OF BUSINESS OR INDUSTRY                    | RAYON WORKER                                                |
| 24. PLACE OF BIRTH OF DECEASED                      | ISLE OF WIGHT, VA.                                          |
| 25. INFORMANT                                       | VA HOSPITAL RECORDS, RICHMOND, VIRGINIA                     |
| 26. CAUSE OF DEATH (PART I)                         | UNDIFFERENTIATED CARCINOMA OF LUNG WITHLEFTPLEURALEFFUSION. |
| 27. DUE TO                                          | [blank]                                                     |
| 28. DUE TO                                          | [blank]                                                     |
| 29. OTHER SIGNIFICANT CONDITIONS                    | 163                                                         |
| 30. AUTOPSY?                                        | NO                                                          |
| 31. IF FEMALE, WAS THERE A PREGNANCY                | [blank]                                                     |
| 32. EXTERNAL CAUSE: WAS IT                          | [blank]                                                     |
| 33. DESCRIBE HOW INJURY OCCURRED                    | [blank]                                                     |
| 34. TIME OF DEATH                                   | 10:15 A.M.                                                  |
| 35. I CERTIFY THAT I ATTENDED THE DECEASEDFROM      | JAN. 20, 1964 TO JAN. 21, 1964                              |
| 36. SIGNATURE OF PHYSICIAN                          | Robert E. Robertson, M.D.                                   |
| 37. ADDRESS OF PHYSICIAN                            | VA HOSPITAL, RICHMOND, VIRGINIA                             |
| 38. DATE SIGNED                                     | 1-23-64                                                     |
| 39. METHOD OF DISPOSITION                           | REMOVAL                                                     |
| 40. PLACE OF DISPOSITION                            | APPOMATTOX CEMETERY, HOPEWELL, VIRGINIA                     |
| 41. FUNERAL DIRECTOR                                | Raymond Gould, DeputyGOULD FUNERAL HOME, HOPEWELL, VIRGINIA |
| 42. DATE RECORD FILED                               | 1/24/64                                                     |
| 43. REGISTRAR                                       | [Illegible]                                                 |
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