Death Certificate of Mattie Cornelia Wellons

Mattie Cornelia Wellons, age 79, died of bronchopneumonia due to a
fractured right hip from a fall on 7 Oct 1961 at Eastern State Hospital,
Williamsburg, Va. She was born 2 Aug 1882 in Virginia to William Wellons
and Susie Francis Davis. A resident of Sedley, Southampton County, she
was widowed. Her occupation was unknown.

------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------
| Field                                                     | Value                         |
|-----------------------------------------------------------|-------------------------------|
| 230                                                                                       |
| 252                                                                                       |
| 25970                                                                                     |
| COPY A FOR BUREAU OF VITAL STATISTICS                                                     |
| FULL NAME OF DECEASED                                     | Mattie Cornelia Wellons       |
| DATE OF DEATH                                             | 10 7 61                       |
| AGE AT DEATH                                              | 79                            |
| SEX                                                       | Female                        |
| COLOR OR RACE                                             | White                         |
| 1. NAME OF HOSPITAL OR INSTITUTION, IF NOT GIVE ADDRESS   | Eastern State Hospital        |
| CITY OR TOWN OF DEATH                                     | Williamsburg, Va.             |
| COUNTY OF DEATH                                           | Williamsburg                  |
| STATE OF DEATH                                            | Va.                           |
| RESIDENCE: STATE                                          | Virginia                      |
| RESIDENCE: COUNTY                                         | Southampton                   |
| RESIDENCE: CITY/TOWN                                      | Sedley                        |
| ADDRESS                                                   | 187                           |
| NAME OF FATHER OF DECEASED                                | William Wellons               |
| MAIDEN NAME OF MOTHER OF DECEASED                         | Susie Francis Davis           |
| CITIZEN OF WHAT COUNTRY                                   | USA                           |
| MARITAL STATUS                                            | Widowed                       |
| VETERAN                                                   | No                            |
| DATE OF BIRTH                                             | 8-2-82                        |
| BIRTHPLACE (STATE OR COUNTRY)                             | Virginia                      |
| NAME OF SPOUSE                                                                            |
| OCCUPATION                                                | Unknown                       |
| PART I. DEATH WAS CAUSED BY: IMMEDIATE CAUSE              | Bronchopneumonia              |
| PART I. DEATH WAS CAUSED BY: DUE TO                       | Fracture of R. Hip            |
| PART I. DEATH WAS CAUSED BY: DUE TO                       | Fall                          |
| INTERVAL BETWEEN ONSET AND DEATH: Bronchopneumonia        | 4 days                        |
| INTERVAL BETWEEN ONSET AND DEATH: Fracture of R. Hip      | 8 days                        |
| INTERVAL BETWEEN ONSET AND DEATH: Fall                    | 8 days                        |
| PART II. OTHER SIGNIFICANT CONDITIONS                     | 9047                          |
| PREGNANCY IN PAST 3 MONTHS?                               | No                            |
| EXTERNAL CAUSE                                            | Accident                      |
| PLACE OF INJURY                                           | Hospital, Williamsburg, Va.   |
| DATE OF INJURY                                            | 9-29-61                       |
| HOUR                                                      | 9:45 AM                       |
| HOW DID INJURY OCCUR                                      | Fell from bed                 |
| AUTOPSY                                                   | No                            |
| CERTIFICATE SIGNED BY                                     | R. E. DeBond, M.D.            |
| MEDICAL EXAMINER                                          | J. W. Garrison                |
| DATE SIGNED                                               | 10/16/61                      |
| FUNERAL DIRECTOR                                          | Rosemont                      |
| ADDRESS (Funeral Director)                                | Courtsey, Sedley, Va.         |
| PLACE OF BURIAL, REMOVAL OR CREMATION                     | Rosemont                      |
| ADDRESS (Place of Burial, Removal or Cremation)           | Sedley, Va.                   |
| REGISTRAR                                                 | Diana B. Parker               |
| DATE FILED                                                | 10/16/61                      |
| EASTERN STATE HOSPITAL RECORDS                            | Williamsburg, Virginia        |
---------------------------------------------------------------------------------------------