Death Certificate of Worrell, K D

K D Worrell, age about 48, died of acute myocarditis on 8 Jun 1931 in
Lakeview Hospital, Suffolk, Nansemond Co., Virginia. He was married to
Olga B. Worrell. Born in Southampton Co., VA to D T. Worrell and Lucy
Britt, he worked as a farmer. He was buried at Newsoms, Va. on 9 Jun
1931.

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| Field                                   | Value                              |
|-----------------------------------------|------------------------------------|
| 1. PLACE OF DEATH                                                            |
| COUNTY OF                               | Nansemond Co.                      |
| MAGISTERIAL DISTRICT OR                 | (not filled)                       |
| IN TOWN OF                              | Suffolk, VA                        |
| REGISTRATION DISTRICT NO.               | 760                                |
| REGISTERED NO.                          | 14960                              |
| WARD                                    | (not filled)                       |
| FULL NAME                               | K D Worrell                        |
| (A) RESIDENCE                           | (not filled)                       |
| PERSONAL AND STATISTICAL PARTICULARS                                         |
| SEX                                     | Male                               |
| COLOR OR RACE                           | White                              |
| SINGLE, MARRIED, WIDOWED, OR DIVORCED   | Married                            |
| SPOUSE:                                 | Olga B. Worrell                    |
| AGE                                     | 48 Years                           |
| OCCUPATION                              | Farmer                             |
| INDUSTRY OR BUSINESS?                   | Own Farm                           |
| LAST WORKED:                            | 1930                               |
| TIME IN OCCUPATION?                     | 20                                 |
| BIRTHPLACE                              | Southampton Co.                    |
| (STATE OR COUNTRY)                      | Va                                 |
| FATHER’S NAME                           | D. T. Worrell                      |
| BIRTHPLACE (STATE OR COUNTRY)           | Va                                 |
| MOTHER’S MAIDEN NAME                    | Lucy Britt                         |
| BIRTHPLACE (STATE OR COUNTRY)           | N.C.                               |
| INFORMANT                               | N. D. Worrell                      |
| ADDRESS                                 |                                    |
| BURIAL, CREMATION, OR REMOVAL           | Interment                          |
| PLACE                                   | Newsoms, Va.                       |
| DATE                                    | June 9, 1931                       |
| UNDERTAKER                              | W. J. M. Holland                   |
| ADDRESS                                 | Franklin, Va                       |
| MEDICAL CERTIFICATE OF DEATH                                                 |
| DATE OF DEATH                           | June 8, 1931                       |
| I ATTENDED DECEASED FROM                | June 6, 1931 TO June 8, 1931       |
| I LAST SAW HIM ALIVE ON                 | 6-8-1931                           |
| DEATH OCCURRED AT                       | 4 AM                               |
| PRINCIPAL CAUSE OF DEATH                | Acute Myocarditis                  |
| DURATION                                | (not filled)                       |
| Contributory causes                     | Flu Infection                      |
| NAME OF OPERATION                       | None                               |
| WHAT TEST CONFIRMED DIAGNOSIS           | Clinical                           |
| WAS THERE AN AUTOPSY?                   | No                                 |
| SIGNATURE                               | L. Rawles, M.D.                    |
| ADDRESS                                 | Suffolk, VA                        |
| DATE SIGNED                             | June 9, 1931                       |
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