Death Certificate of John Otis Story

John Otis Story, age 55, died on 3 Apr 1951 in Franklin, Southampton,
Virginia. Cause of death was pulmonary tuberculosis due to congestive
heart failure. He was married to Nancy Harcum Story and lived on Hill
Street, Franklin. Born 16 Oct 1895 in Southampton Co., Virginia, he was
the son of Rufus Story and Ella Turner.

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| Field                                   | Value                                        |
|-----------------------------------------|----------------------------------------------|
| 1. COUNTY                               | Southampton                                  |
| 2. MAGISTERIAL DISTRICT                 | Franklin                                     |
| 3. CITY OR TOWN                         | Franklin                                     |
| 4. HOSPITAL OR INSTITUTION                                                             |
| 5. LENGTH OF STAY                                                                      |
| 6a. STATE                               | Virginia                                     |
| 6b. COUNTY                              | Southampton                                  |
| 6c. CITY OR TOWN                        | Franklin                                     |
| 6d. ADDRESS                             | Hill Street                                  |
| 6e. INSIDE CITY LIMITS                  | checked                                      |
| 6f. OUTSIDE CITY LIMITS                 | not checked                                  |
| NAME OF DECEASED                        | John Otis Story                              |
| SEX                                     | Male                                         |
| COLOR OR RACE                           | White                                        |
| MARITAL STATUS                          | Married                                      |
| DATE OF BIRTH                           | October 16, 1895                             |
| AGE                                     | 55 Years 5 Months 18 Days                    |
| TRADE, PROFESSION, ETC?                 | Farmer                                       |
| KIND OF BUSINESS OR INDUSTRY            | Farm                                         |
| BIRTHPLACE                              | Southampton Co., Va.                         |
| FATHER'S NAME                           | Rufus Story                                  |
| MOTHER'S MAIDEN NAME                    | Ella Turner                                  |
| INFORMANT'S SIGNATURE                   | Mrs John O. Story                            |
| INFORMANT'S ADDRESS                                                                    |
| PERSONAL DATA - DATE OF DEATH           | April 3, 1951                                |
| PERSONAL DATA - AGE                     | 55 Years 5 Months 18 Days                    |
| PERSONAL DATA - PLACE OF DEATH          | Franklin, Southampton, Virginia              |
| PERSONAL DATA - USUAL RESIDENCE         | Hill Street, Franklin, Southampton, Virginia |
| PERSONAL DATA - OCCUPATION              | Farmer                                       |
| PERSONAL DATA - INDUSTRY                | Farm                                         |
| PERSONAL DATA - BIRTHPLACE              | Southampton Co., Va.                         |
| PERSONAL DATA - FATHER                  | Rufus Story                                  |
| PERSONAL DATA - MOTHER                  | Ella Turner                                  |
| PERSONAL DATA - INFORMANT               | Mrs John O. Story                            |
| 18a. CAUSE OF DEATH                     | Pulmonary Tuberculosis                       |
| 18a. INTERVAL BETWEEN ONSET AND DEATH   | ?                                            |
| 18b. CAUSE OF DEATH                     | Congestive Heart Failure                     |
| 18b. INTERVAL BETWEEN ONSET AND DEATH   | ?                                            |
| 18. OTHER SIGNIFICANT CONDITIONS        | 007                                          |
| 19. DATE OF OPERATION                                                                  |
| 20. AUTOPSY?                            | NO                                           |
| 21. ACCIDENT, SUICIDE, OR HOMICIDE                                                     |
| 21b. PLACE OF INJURY                                                                   |
| 21c. CITY, TOWN, OR COUNTY                                                             |
| 21e. INJURY OCCURRED - Work                                                            |
| 21e. INJURY OCCURRED - At Work                                                         |
| 21f. HOW DID INJURY OCCUR                                                              |
| CERTIFICATION - ATTENDED FROM           | April 2, 1951                                |
| CERTIFICATION - LAST SAW ALIVE          | April 3, 1951                                |
| CERTIFICATION - TIME OF DEATH           | 3:10 P.M.                                    |
| CERTIFICATION - SIGNATURE               | M. M. Smith, M.D.                            |
| CERTIFICATION - ADDRESS                 | Franklin, Va.                                |
| CERTIFICATION - DATE SIGNED             | Apr. 6, 1951                                 |
| 24a. BURIAL, CREMATION, OR REMOVAL      | Burial                                       |
| 24b. DATE                               | April 6, 1951                                |
| 24c. NAME OF CEMETERY OR CREMATORY      | Poplar Spring Cem                            |
| 24d. LOCATION                           | Franklin, Virginia                           |
| FUNERAL DIRECTOR'S SIGNATURE            | Holland & Sons Inc                           |
| FUNERAL DIRECTOR'S ADDRESS              | Franklin, Virginia                           |
| REGISTRAR'S SIGNATURE                   | Mrs. J A Cook                                |
| DATE RECEIVED                           | April 9, 1951                                |
| State File No.                          | 9768                                         |
| Registered No.                          | 47                                           |
| Registration District                   | 2874                                         |
| Primary Registration District No.       | 0871                                         |
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