Death Certificate of Johnson, Herman L

Herman L. Johnson was born 10 Apr 1908 in Southampton Co VA to James F.
Johnson and Martha A. Francis. He died on 28 Oct 1943 at 2:30 A.M. in
Northampton County, NC as a result of an auto accident that caused
crushed injuries to his left side and left lung. The accident occurred
on State Highway near Garysburg. At the time of his death, he was 33
years old.

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| ID   | Section                 | Field Description                                         | Value                                   |
|------|-------------------------|-----------------------------------------------------------|-----------------------------------------|
| 1    | PLACE OF DEATH          | County                                                    | Northampton                             |
| 2    | PLACE OF DEATH          | Township                                                  |                                         |
| 3    | PLACE OF DEATH          | City or Town                                              | Whitakers                               |
| 4    | PLACE OF DEATH          | Street, hospital or institution                           |                                         |
| 5    | PLACE OF DEATH          | Length of stay in hospital or institution                 |                                         |
| 6    | PLACE OF DEATH          | In this community (yrs., mos., or days)                   |                                         |
| 7    | HOME OF DECEASED        | State                                                     | N.C.                                    |
| 8    | HOME OF DECEASED        | County                                                    | Halifax                                 |
| 9    | HOME OF DECEASED        | City or Town                                              | Roanoke Rapids                          |
| 10   | HOME OF DECEASED        | Street or R.F.D.                                          |                                         |
| 11   | HOME OF DECEASED        | Is place of residence in corporate limits?                | No                                      |
| 12   | HOME OF DECEASED        | If foreign born, how long in U.S.A.?                      |                                         |
| 13   | FULL NAME               | Full Name                                                 | Herman L Johnson                        |
| 14   | FULL NAME               | Social Security Number                                    |                                         |
| 15   | FULL NAME               | If veteran, name war                                      |                                         |
| 16   | FULL NAME               | Color or Race                                             | White                                   |
| 17   | FULL NAME               | Single, married, widowed, divorced                        | Married                                 |
| 18   | SPOUSE                  | Name of husband or wife                                   | Willie Bell Dickerson                   |
| 19   | SPOUSE                  | Age of husband or wife if alive                           | 24 yrs                                  |
| 20   | BIRTH                   | Date of birth (month, day, year)                          | Apr 10, 1908                            |
| 21   | AGE                     | Age                                                       | 35 yrs                                  |
| 22   | BIRTHPLACE              | Birthplace (City, State or country)                       | Southampton County Va                   |
| 23   | OCCUPATION              | Usual occupation                                          | Farmer                                  |
| 24   | INDUSTRY                | Industry or business                                      |                                         |
| 25   | FATHER                  | Name                                                      | James F Johnson                         |
| 26   | FATHER                  | Birthplace                                                | Southampton County                      |
| 27   | MOTHER                  | Maiden Name                                               | Martha A Francis                        |
| 28   | MOTHER                  | Birthplace                                                | Southampton County                      |
| 29   | INFORMANT               | Name                                                      | James F Johnson                         |
| 30   | INFORMANT               | Address                                                   | Franklin Va.                            |
| 31   | BURIAL/CREMATION        | Date                                                      | Sept 29-43                              |
| 32   | BURIAL/CREMATION        | Place                                                     | Roanoke Rapids N.C.                     |
| 33   | FUNERAL DIRECTOR        | Name                                                      | W C Williamson                          |
| 34   | FUNERAL DIRECTOR        | Address                                                   | Roanoke Rapids N.C.                     |
| 35   | REGISTRAR               | Date received by registrar                                | 10/29/43                                |
| 36   | REGISTRAR               | Registrar signature                                       | W. C. Ellis                             |
| 37   | MEDICAL CERTIFICATION   | Date of death                                             | Oct 28, 1943                            |
| 38   | MEDICAL CERTIFICATION   | Time of death                                             | 2:30 A.M.                               |
| 39   | MEDICAL CERTIFICATION   | Immediate cause of death                                  | Crushed left side and left lung         |
| 40   | MEDICAL CERTIFICATION   | Due to                                                    | Auto accident                           |
| 41   | MEDICAL CERTIFICATION   | Other conditions                                          |                                         |
| 42   | MEDICAL CERTIFICATION   | Major findings of operation                               | None                                    |
| 43   | MEDICAL CERTIFICATION   | Autopsy                                                   | None                                    |
| 44   | MEDICAL CERTIFICATION   | If death due to external causes, fill in:                 | Accident                                |
| 45   | MEDICAL CERTIFICATION   | Date of occurrence                                        | Sep 28, 1943                            |
| 46   | MEDICAL CERTIFICATION   | Where did injury occur?                                   | Garysburg, Northampton, N.C.            |
| 47   | MEDICAL CERTIFICATION   | Did injury occur at home, farm, industrial, public place? | State Highway                           |
| 48   | MEDICAL CERTIFICATION   | While at work?                                            | No                                      |
| 49   | MEDICAL CERTIFICATION   | Means of injury                                           | Auto accident                           |
| 50   | PHYSICIAN               | Signature                                                 | R. L, Grant (Coroner)                   |
| 51   | PHYSICIAN               | Address                                                   | Jackson, N.C.                           |
| 52   | PHYSICIAN               | Date signed                                               | 10/29/43                                |