Death Certificate of Vick, Villa P.

Villa P. Vick, age 70, died of congestive heart failure due to
arteriosclerotic heart disease on 15 Jul 1956 at Raiford Memorial
Hospital, Franklin, Southampton, Virginia. She was born 28 Aug 1885 in
Southampton County, Virginia, to George Drake and Martha Elizabeth
Johnson. Villa was widowed, spouse Cilas L. Vick, and resided in
Newsoms, Southampton, Virginia.

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| Field                                                   | Value                                       |
|---------------------------------------------------------|---------------------------------------------|
| 1. PLACE OF DEATH a. COUNTY                             | Southampton                                 |
| 1. PLACE OF DEATH b. CITY OR TOWN                       | Franklin                                    |
| 1. PLACE OF DEATH c. HOSPITAL OR INSTITUTION            | Raiford Memorial Hospital                   |
| 1. PLACE OF DEATH d. LENGTH OF STAY                     | [Blank]                                     |
| 1. PLACE OF DEATH e. INSIDE CITY OR TOWN LIMITS         | [X] Inside [ ] Outside [ ] Corporate Limits |
| 2. USUAL RESIDENCE a. STATE                             | Virginia                                    |
| 2. USUAL RESIDENCE b. COUNTY                            | Southampton                                 |
| 2. USUAL RESIDENCE c. CITY OR TOWN                      | Newsoms                                     |
| 2. USUAL RESIDENCE d. ADDRESS                           | 0870                                        |
| 2. USUAL RESIDENCE e. (If rural, give mailing address)  | [Blank]                                     |
| 2. USUAL RESIDENCE f. INSIDE CITY OR TOWN LIMITS        | [X] Inside [ ] Outside [ ] Corporate Limits |
| 3. NAME OF DECEASED (First)                             | Villa                                       |
| 3. NAME OF DECEASED (Middle)                            | P.                                          |
| 3. NAME OF DECEASED (Last)                              | Vick                                        |
| 4. DATE OF DEATH                                        | July 15th, 1956                             |
| 5. SEX                                                  | Female                                      |
| 6. COLOR OR RACE                                        | White                                       |
| 7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED            | Widowed                                     |
| 8. DATE OF BIRTH                                        | August 28th, 1885                           |
| 9. AGE                                                  | 70 Years 10 Months 17 Days                  |
| 10a. USUAL OCCUPATION                                   | Housewife                                   |
| 10b. KIND OF BUSINESS OR INDUSTRY                       | Domestic                                    |
| 11. BIRTHPLACE                                          | Southampton Co                              |
| 12. CITIZEN OF WHAT COUNTRY                             | USA                                         |
| 13. FATHER'S NAME                                       | George Drake                                |
| 14. MOTHER'S MAIDEN NAME                                | Martha Elizabeth Johnson                    |
| 15. NAME OF HUSBAND OR WIFE OF DECEASED                 | Cilas L. Vick                               |
| 17. INFORMANT'S NAME                                    | Mrs. Alese V. Carr                          |
| 17. INFORMANT'S ADDRESS                                 | Franklin, Virginia                          |
| 18a. CAUSE OF DEATH                                     | Congestive Heart Failure                    |
| 18b. DUE TO (or as a consequence of)                    | Arteriosclerotic Heart Disease              |
| INTERVAL BETWEEN ONSET AND DEATH                        | 1 day                                       |
| OTHER SIGNIFICANT CONDITIONS                            | 10 yrs.                                     |
| 20. AUTOPSY?                                            | [ ] YES [X] NO                              |
| 22. CERTIFYING PHYSICIAN'S STATEMENT                    | I hereby certify                            |
| 22. SIGNATURE                                           | H L Gardner Jr. M.D.                        |
| 22. ADDRESS                                             | Franklin, Virginia                          |
| 22. DATE SIGNED                                         | 7-18-56                                     |
| 23a. BURIAL, CREMATION, REMOVAL                         | Burial                                      |
| 23b. DATE                                               | July 15, 1956                               |
| 23c. NAME OF CEMETERY OR CREMATORY                      | Beechwood Cemetery                          |
| 23d. LOCATION                                           | Boykins, Virginia                           |
| 24. FUNERAL DIRECTOR'S SIGNATURE                        | W.J.M. Holland & Sons Inc                   |
| 24. FUNERAL DIRECTOR'S ADDRESS                          | Franklin, Virginia                          |
| REGISTRAR'S SIGNATURE AND DATE                          | July 18, 1956 J. A. Cook                    |
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