Death Certificate of Gray, Richard Benjamin

Richard Benjamin Gray, age 78, was born 8 May 1861 in Southampton Co.,
Virginia, to Benjamin Gray and Martha Barrett. He resided near Newsoms,
Virginia, and was married to Sallie Ferguson Gray. He died 26 Aug 1939
in Southampton, Virginia. Cause of death was chronic nephritis.

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| Field                                                             | Value                                                   |
|-------------------------------------------------------------------|---------------------------------------------------------|
| 1. PLACE OF DEATH                                                 | Southampton                                             |
| COUNTY OF                                                         | Southampton                                             |
| MAGISTERIAL DISTRICT OF                                           | Newsoms                                                 |
| OR INC. TOWN, OR CITY OF                                          | Va.                                                     |
| 2. FULL NAME                                                      | Richard Benjamin Gray                                   |
| (A) RESIDENCE, No.                                                | Near Newsoms                                            |
| 3. SEX                                                            | Male                                                    |
| 4. COLOR OR RACE                                                  | White                                                   |
| 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED                          | Married                                                 |
| 5A. SPOUSE:                                                       | Husband of Sallie Ferguson Gray                         |
| 6. DATE OF BIRTH                                                  | May 8, 1861                                             |
| 7. AGE                                                            | 78 3 18                                                 |
| 8. TRADE, PROFESSION, ETC?                                        | Retired Farmer                                          |
| 9. INDUSTRY OR BUSINESS?                                          | Farm                                                    |
| 10. LAST WORKED:                                                  | Not stated                                              |
| 11. TIME IN OCCUPATION?                                           | Southampton Co.                                         |
| 12. BIRTHPLACE                                                    | Southampton Co.                                         |
| 13. NAME OF FATHER                                                | Benjamin Gray                                           |
| 14. BIRTHPLACE OF FATHER                                          | Virginia                                                |
| 15. MAIDEN NAME OF MOTHER                                         | Martha Barrett                                          |
| 16. BIRTHPLACE OF MOTHER                                          | Virginia                                                |
| 17. INFORMANT (ADDRESS)                                           | R.P. Gray, Newsoms, Va.                                 |
| 18. BURIAL, CREMATION, OR REMOVAL                                 | Newsoms, 8-27-39                                        |
| 19. UNDERTAKER (ADDRESS)                                          | W.J.M. Holland & Son, Franklin, Virginia                |
| 20. FILED                                                         | 8-29-1939                                               |
| (Registrar)                                                       | Mrs. C.R. Everett                                       |
| 21. DATE OF DEATH                                                 | Aug. 26, 1939                                           |
| 22. MEDICAL CERTIFICATE OF DEATH                                  | I ATTENDED DECEASED FROM Aug. 18, 1939 TO Aug. 24, 1939 |
| LAST SAW ALIVE ON                                                 | Aug. 24, 1939                                           |
| PRINCIPAL CAUSE OF DEATH:                                         | Chronic nephritis                                       |
| CONTRIBUTORY CAUSES OF IMPORTANCE NOT RELATED TO PRINCIPAL CAUSE  |                                                         |
| NAME OF OPERATION                                                 |                                                         |
| DATE OF OPERATION                                                 |                                                         |
| WHAT TEST CONFIRMED DIAGNOSIS?                                    |                                                         |
| WAS THERE AN AUTOPSY?                                             | No                                                      |
| 23. DEATH DUE TO                                                  |                                                         |
| DATE OF INJURY                                                    |                                                         |
| WHERE DID INJURY OCCUR                                            |                                                         |
| Industry, home, or public place?                                  |                                                         |
| MANNER OF INJURY                                                  |                                                         |
| 24. RELATED TO OCCUPATION?                                        | No                                                      |
| IF SO, SPECIFY                                                    |                                                         |
| (SIGNED)                                                          | B.G. Pope, M.D.                                         |
| (ADDRESS)                                                         | Newsoms, Va.                                            |
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