Death Certificate of Gray, Martha L.

Martha L. Gray, age 64, died of malaria & pneumonia on 22 Aug 1913 in
Windsor, Isle of Wight County, Virginia. She was widowed, born in
Southampton. Her occupation was housekeeper. Burial took place in
Southampton on 23 Aug 1913.

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| Field                                               | Value                            |
|-----------------------------------------------------|----------------------------------|
| PLACE OF DEATH County of                            | Isle of Wight, Va.               |
| PLACE OF DEATH City or Town of                      | Windsor                          |
| File No.                                            | 30778                            |
| 2. FULL NAME                                        | Martha L. Gray                   |
| 3. SEX                                              | Female                           |
| 4. COLOR OR RACE                                    | White                            |
| 5. Single, Married, Widowed or Divorced             | Widowed                          |
| 6. DATE OF BIRTH                                    | (blank)                          |
| 7. AGE                                              | 64 yrs.                          |
| 8. OCCUPATION                                       | Housekeeper                      |
| 9. BIRTHPLACE (State or Country)                    | Southampton                      |
| 10. NAME OF FATHER                                  | [Illegible]                      |
| 11. BIRTHPLACE OF FATHER (State or Country)         |                                  |
| 12. MAIDEN NAME OF MOTHER                           | Gray                             |
| 13. BIRTHPLACE OF MOTHER (State or Country)         |                                  |
| 14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE   | C. A. Gray                       |
| 14. Address                                         | Franklin, Va.                    |
| Filed                                               | Aug. 22, 1913                    |
| LOCAL REGISTRAR                                     | J. F. Dake                       |
| 17. DATE OF DEATH                                   | Aug. 22, 1913                    |
| I attended deceased from                            | Aug. 15, 1913 to Aug. 22, 1913   |
| Last saw alive on                                   | Aug. 21, 1913                    |
| Death occurred at                                   | 5 a.m.                           |
| CAUSE OF DEATH                                      | Malaria & Pneumonia              |
| Contributory (Secondary)                            | (blank)                          |
| Duration                                            | 10 ds.                           |
| Signed                                              | Asbley P [Illegible], M.D.       |
| Date (Medical Certificate)                          | 8/23/1913                        |
| Address (Physician)                                 | Franklin, Va.                    |
| PLACE OF BURIAL OR REMOVAL                          | [Illegibe] Southampton           |
| DATE OF BURIAL                                      | Aug. 23, 1913                    |
| UNDERTAKER                                          | W M Holland                      |
| ADDRESS (Undertaker)                                | Frannklin, Va.                   |
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