Death Certificate of Annie Dora Gray

Annie Dora Gray died of puerperal septicemia on 1 Mar 1915 in Newsoms,
Southampton County, Virginia, at age 40. Born 15 Jan 1875 in Southampton
Co., Virginia, to George Drake and Martha E. Drake, she was married,
worked as a housewife, and lived in Newsoms. She was buried near Newsoms
on 3 Mar 1915.

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| Field                                                           | Value                          |
|-----------------------------------------------------------------|--------------------------------|
| 1. PLACE OF DEATH County of                                     | Southampton                    |
| 1. PLACE OF DEATH Magisterial District or                       | Newsoms                        |
| 2. FULL NAME                                                    | Annie Dora Gray                |
| 4. SEX                                                          | Female                         |
| 5. COLOR OR RACE                                                | White                          |
| 6. DATE OF BIRTH                                                | January 15, 1875               |
| 7. AGE                                                          | 40 yrs., 15 d.                 |
| 8. OCCUPATION (a) TRADE, PROFESSION, ETC?                       | Housewife                      |
| 9. BIRTHPLACE (State or Country)                                | Southampton Co. Va             |
| 10. NAME OF FATHER                                              | George Drake                   |
| 11. BIRTHPLACE OF FATHER (State or Country)                     | Va.                            |
| 12. MAIDEN NAME OF MOTHER                                       | Martha E. Drake                |
| 13. BIRTHPLACE OF MOTHER (State or Country)                     | Virginia                       |
| 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE (Informant)   | P. H. Drake                    |
| 14. (Address)                                                   | Newsoms                        |
| 15. Filed (Date received by Registrar)                          | March 4, 1915                  |
| 15. (Local Registrar)                                           | Solom L. Bryant                |
| 16. DATE OF DEATH                                               | March 2, 1915                  |
| 17. I ATTENDED DECEASED FROM                                    | Feb. 27, 1915 to Mar. 2, 1915  |
| 17. That I last saw her alive on                                | Mar. 1, 1915                   |
| 17. Death occurred, on the date stated above, at                | 12:15 PM                       |
| 17. THE CAUSE OF DEATH                                          | Puerperal septicemia           |
| 17. (Duration)                                                  | 3 days                         |
| 17. Contributory (SECONDARY)                                    | [blank]                        |
| 17. (Duration)                                                  | [blank]                        |
| 17. (Signed)                                                    | B. A Pope, M.D.                |
| 17. (Date)                                                      | March 3, 1915                  |
| 17. (Address)                                                   | Boykins, Va.                   |
| 18. Length of residence:                                        | [blank]                        |
| 19. PLACE OF BURIAL OR REMOVAL                                  | Near Newsoms                   |
| 19. DATE OF BURIAL                                              | March 3, 1915                  |
| 19. UNDERTAKER                                                  | W. J. M. Holland               |
| 19. ADDRESS                                                     | Franklin, Va.                  |
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[Brith Register has date of birth as January 5, 1875]