Death Certificate of Ferguson, Patrick Thomas

Patrick Thomas Ferguson, age 0, died on 6 Jan 1967 at Greensville Memorial Hospital in Emporia, Virginia. He was a never married and resided in Boykins, Southampton County, Virginia. Born on 6 Jan 1867 in Virginia to Joseph Thomas Ferguson and Jackie Paige Porter, he was an infant at the time of death. The immediate cause of death was pre-maternity. He was buried in Newsoms, Southampton County, Virginia.

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| Field                                               | Value                                 |
|-----------------------------------------------------|---------------------------------------|
| REGISTRATION AREA NUMBER                            | 140                                   |
| CERTIFICATE NUMBER                                  | 5                                     |
| STATE FILE NUMBER                                   | 67 002364                             |
| 1. FULL NAME OF DECEASED                            | Patrick Thomas Ferguson               |
| 2. SEX                                              | male                                  |
| 3. DATE OF DEATH (mo., day, yr.)                    | 1-6-67                                |
| 4. AGE                                              | 0 yrs                                 |
| 5. COLOR OR RACE                                    | White                                 |
| 6. NAME OF HOSPITAL OR INSTITUTION (If none, so st  | Greensville Memorial Hospital         |
| 7. CITY OR TOWN OF DEATH                            | Emporia                               |
| 8. COUNTY OF DEATH (If independent city, leave bla  | Southampton                           |
| 9. STREET ADDRESS OR R.F.D. NO. OF PLACE OF DEATH   | (blank)                               |
| 10. STATE (OR FOREIGN COUNTRY) OF DECEDENT'S RESID  | Virginia                              |
| 11. COUNTY OF RESIDENCE                             | Southampton                           |
| 12. CITY OR TOWN OF RESIDENCE                       | Boykins                               |
| 13. STREET ADDRESS OR R.F.D. NO. OF RESIDENCE       | 187                                   |
| 14. NAME OF FATHER OF DECEASED                      | Joseph Thomas Ferguson                |
| 15. MAIDEN NAME OF MOTHER OF DECEASED               | Jackie Paige Porter                   |
| 16. BIRTH COUNTRY                                   | USA                                   |
| 17. MARRIED ☐ NEVER MARRIED ☐ WIDOWED ☒ DIVORCED ☐  | NEVER MARRIED                         |
| 18. NAME OF SPOUSE                                  | (blank)                               |
| 19. VETERAN ☐ Yes ☒ No                              | No                                    |
| 20. USUAL OR LAST OCCUPATION                        | (blank)                               |
| 21. KIND OF BUSINESS OR INDUSTRY                    | (blank)                               |
| 22. BIRTHPLACE OF DECEASED                          | Virginia                              |
| 23. INFORMANT OR SO SOURCE OF INFORMATION           | (blank)                               |
| 24. DATE OF BIRTH OF DECEASED (mo., day, yr.)       | 1-6-85                                |
| 26. CAUSE OF DEATH (Enter only one cause per line   | Pre-maternity                         |
| 26b. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO   | 776                                   |
| 26c. AUTOPSY? ☐ Yes ☒ No                            | No                                    |
| 26d. WAS DEATH DUE TO: ACCIDENT ☐ SUICIDE ☐ HOMICI  | NATURAL CAUSES                        |
| 26e. IF FEMALE, WAS THERE A PREGNANCY IN THE PAST   | Unknown                               |
| 26f. PLACE OF INJURY (If accident, suicide or homi  | (blank)                               |
| 26g. DESCRIBE HOW INJURY OCCURRED                   | (blank)                               |
| 27. DATE OF DEATH                                   | 1-6-67                                |
| 28. TIME OF DEATH                                   | 8:13 A.M.                             |
| 29. ACTUAL ☐ APPROXIMATE ☐ PRESUMED ☐ FOUND ON ☐    | ACTUAL                                |
| 30. SIGNATURE OF PHYSICIAN                          | (signature present)                   |
| 31. DATE SIGNED                                     | 1-6-67                                |
| 32. ADDRESS                                         | Emporia, VA                           |
| 33. NAME OF FUNERAL DIRECTOR                        | McDowell Funeral Home                 |
| 34. ADDRESS OF FUNERAL DIRECTOR                     | Boykins, Virginia                     |
| 35. METHOD OF DISPOSITION                           | Burial                                |
| 36. PLACE OF DISPOSITION                            | Newsoms                               |
| 37. DATE OF DISPOSITION                             | 1-8-67                                |
| 38. SIGNATURE OF REGISTRAR                          | (signature present)                   |
| 39. DATE RECEIVED BY REGISTRAR                      | 1-10-67                               | 
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