Death Certificate of William Henry Johnson

William Henry Johnson, 84, died on 4 Mar 1952 in Carrsville, Isle of
Wight County, Virginia from emphysema and chronic myocarditis. A
resident of Carrsville, he was married to Nancy Carr Johnson and was
buried on 6 Mar 1952 at Beaver Dam Church Cemetery, near Franklin,
Virginia.

Mr. Johnson was the son of Jordon Johnson and Martha Johnson. He worked
as a retired farmer and lived in Carrsville, Virginia. He was buried at
Beaver Dam Church Cemetery, near Franklin, Virginia.

|--------------------------------------------------------------------------------------------------|
| Field                                   | Value                                                  |
|-----------------------------------------|--------------------------------------------------------|
| 1. COUNTY OF                            | Isle of Wight                                          |
| 2. CITY OR TOWN                         | Carrsville, Va.                                        |
| 3. Hospital or Institution              | ☒ At home  | [At home checked,                         |
| 4. LENGTH OF STAY                       | [blank]                                                |
| 5. INSIDE / OUTSIDE ☒ Corporate Limits  | [Outside checked, Inside unchecked]                    |
| HEALTH DISTRICT                         | Windsor                                                |
| 6. STATE                                | Virginia                                               |
| 7. COUNTY                               | Isle of Wight                                          |
| 8. CITY OR TOWN                         | Carrsville, Va.                                        |
| 9. STREET                               | [blank]                                                |
| 10. ADDRESS                             | Carrsville, Va.                                        |
| NAME OF DECEASED                        | William                                                |
| NAME OF DECEASED                        | Henry                                                  |
| NAME OF DECEASED                        | Johnson                                                |
| SEX                                     | Male                                                   |
| COLOR OR RACE                           | White                                                  |
| MARITAL STATUS                          | Married                                                |
| DATE OF BIRTH                           | July 25, 1867                                          |
| AGE                                     | 84 Years                                               |
| BIRTHPLACE                              | Isle of Wight Co                                       |
| CITIZEN OF WHAT COUNTRY                 | USA                                                    |
| FATHER'S NAME                           | Jordon Johnson                                         |
| MOTHER'S MAIDEN NAME                    | Martha Johnson                                         |
| VETERAN                                 | [blank]                                                |
| HUSBAND OR WIFE OF DECEASED             | Nancy Carr Johnson                                     |
| USUAL OCCUPATION                        | Retired Farmer                                         |
| KIND OF INDUSTRY OR BUSINESS?           | Owner                                                  |
| INFORMANT'S SIGNATURE                   | Mrs. W. H. Johnson                                     |
| CAUSE OF DEATH                          | Emphysema and chronic myocarditis                      |
| INTERVAL BETWEEN ONSET AND DEATH        | D.K.                                                   |
| ANTECEDENT CAUSES                       | [blank]                                                |
| OTHER SIGNIFICANT CONDITIONS            | [blank]                                                |
| Date of Operation                       | [blank]                                                |
| Major Findings of Operation             | [blank]                                                |
| Accident, Suicide, Homicide             | [blank]                                                |
| DATE OF DEATH                           | March 4, 1952                                          |
| PLACE OF INJURY                         | [blank]                                                |
| INJURY OCCURRED                         | ☐ At Work  | ☐ Not at Work | [both unchecked]          |
| HOW DID INJURY OCCUR                    | [blank]                                                |
| Last physician seen alive               | February 19th, 1952                                    |
| Death occurred at                       | 12:30 PM                                               |
| SIGNATURE OF PHYSICIAN                  | [signature]                                            |
| DATE SIGNED                             | 3/5/52                                                 |
| ADDRESS                                 | Holland, Va.                                           |
| BURIAL, CREMATION, REMOVAL              | Burial                                                 |
| DATE OF BURIAL                          | March 6, 1952                                          |
| NAME OF CEMETERY OR CREMATORY           | Beaver Dam Church Cem.                                 |
| LOCATION                                | Near Franklin, Va.                                     |
| FUNERAL DIRECTOR'S SIGNATURE            | W. J. M. Holland & Sons Inc.                           |
| ADDRESS                                 | Franklin, Virginia                                     |
| REGISTRAR'S SIGNATURE                   | [signature]                                            |
| DATE RECEIVED                           | 3/10/52                                                |
| Form                                    | VS-4 REVISED 4-49                                      |
|--------------------------------------------------------------------------------------------------|

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