Death Certificate of Duck, Thomas R

Narrative summary of the form data:

Thomas R Duck, a 51-year-old male born on 28 Nov 1877 in Isle of Wight
Co., son of Mills S. Duck and Mary Johnson, resided in Isle of Wight,
Windsor. He was widowed. He died on 16 May 1924 in Isle of Wight,
Windsor, from [Illegible] and general syphilis.

----------------------------------------------------------------------------
| 1 PLACE OF DEATH                          | Isle of Wight, Windsor       |
|-------------------------------------------|------------------------------|
| 2 FULL NAME                               | Thomas R, Duck               |
| 3 SEX                                     | Male                         |
| 4 COLOR OR RACE                           | White                        |
| 5A IF MARRIED, WIDOWED, OR DIVORCED       | Widow                        |
| 6 DATE OF BIRTH                           | Nov 28 1877                  |
| 7 AGE                                     | 51 yrs 5 mos                 |
| 8 OCCUPATION OF DECEASED                  | Clerk Gen. Mds.              |
| 9 BIRTHPLACE                              | Isle of Wight Co.            |
| 10 NAME OF FATHER                         | Mills S. Duck                |
| 11 BIRTHPLACE OF FATHER                   | Isle of Wight                |
| 12 MAIDEN NAME OF MOTHER                  | Mary Johnson                 |
| 13 BIRTHPLACE OF MOTHER                   | Isle of Wight                |
| 14 INFORMANT                              | W. F. Duck, Rum Hill         |
| 15 FILED                                  | May 18 1924, Ethel L. Dennis |
| 16 DATE OF DEATH                          | May 16 1924                  |
| 17 TIME OF DEATH                          | 4:10 A.M.                    |
| 18 WHERE WAS DISEASE CONTRACTED           | Not at place of death        |
| 18A DISEASE CAUSING DEATH                 | [Illegible]                  |
| 18B DURATION (PRIMARY)                    | 8 1/2 yrs                    |
| 18C CONTRIBUTORY (SECONDARY)              | General Syphilis             |
| 18D DURATION (SECONDARY)                  | 3 yrs                        |
| 19 PLACE OF BURIAL, CREMATION, OR REMOVAL | Near Walters                 |
| 20 DATE OF BURIAL                         | May 18 1924                  |
| 21 UNDERTAKER                             | W. M. Fullenius, Franklin    |
----------------------------------------------------------------------------