Death Certificate of Joyner, Mary Clifton

Narrative summary of the form data:

Mary Clifton Joyner, age 83, was born on 21 Aug 1885 in Virginia to
Joseph Joyner and Nannie Drewry. She resided in Franklin, Virginia. She
was widowed. Mary died on 18 Sep 1968 at Southampton Memorial Hospital,
Franklin, Virginia. Cause of death was uremia due to generalized
arteriosclerosis.

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| Field Name (with prefix)                              | Value                                        |
|-------------------------------------------------------|----------------------------------------------|
| Registration Area Number                              | 233                                          |
| Certificate Number                                    | 111                                          |
| State File Number                                     | 68 026065                                    |
| 1. Full Name of Deceased                              | Mary Clifton Joyner                          |
| 2. Sex                                                | Female                                       |
| 3. Date of Death                                      | September 18, 1968                           |
| 4. Age of Deceased                                    | 83 years                                     |
| 5. Color or Race                                      | White                                        |
| 6. Name of Hospital or Institution                    | Southampton Memorial Hospital                |
| 7. County of Death                                    | Franklin                                     |
| 8. City or Town of Death                              | Franklin                                     |
| 9. Street Address or R.F.D. No. of Place of Death     | 100 Fairview Drive                           |
| 10. County of Decedent's Residence                    | Southampton                                  |
| 11. Usual Residence - State                           | Virginia                                     |
| 12. Usual Residence - City or Town                    | Franklin 23851                               |
| 13. Usual Residence - Street Address or R.F.D. No.    | Route #2                                     |
| 14. Name of Father of Deceased                        | Joseph Joyner                                |
| 15. Maiden Name of Mother of Deceased                 | Nannie Drewry                                |
| 16. Deceased Citizen of What Country                  | USA                                          |
| 17. Marital Status                                    | Widowed                                      |
| 18. Name of Spouse                                    | [Blank]                                      |
| 19. Birthplace of Deceased                            | Virginia                                     |
| 20. Date of Birth of Deceased                         | 8-21-1885                                    |
| 21. Social Security Number                            | [Blank]                                      |
| 22. Usual Occupation                                  | Domestic                                     |
| 23. Kind of Business or Industry                      | [Blank]                                      |
| 24. If Veteran                                        | No                                           |
| 25. Hospital Record Number                            | S-9468                                       |
| 26. Cause of Death - Immediate Cause                  | Uremia                                       |
| 26a. Due to (or as a consequence of)                  | Generalized Arteriosclerosis                 |
| 26b. Interval Between Onset and Death                 | 1 week                                       |
| 26c. Other Significant Conditions                     |                                              |
| 27. If Female, Was There a Pregnancy in Past 3 Months | No                                           |
| 28. Was Autopsy Performed?                            | No                                           |
| 29. Time of Death                                     | 4:15                                         |
| 30. Actual/Presumed/Approximate                       | Actual                                       |
| 31. Place of Burial/Removal/Cremation                 | Blackcreek Church Cemetery, Franklin,Va.,RFD |
| 32. Date of Burial/Removal/Cremation                  | 9-19-68                                      |
| 33. Name of Funeral Director                          | W.J.M. Holland & Sons Inc                    |
| 34. Name of Person Providing Medical Certification    | H.L. Gardner, M.D.                           |
| 35. Date Signed by Medical Certifier                  | 9-19-68                                      |
| 36. Registrar Name                                    | Roberto L. Smith                             |
| 37. Date Received by Registrar                        | 9/24/68                                      |
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