EWP 4-5 Yr 1926 Bagby Nettie Death
Item
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Title
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EWP 4-5 Yr 1926 Bagby Nettie Death
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Description
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Death Certificate for Nettie Bagby
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Tag
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Death Certificate
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Place
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Virginia
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Identifier
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1023487
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Is Version Of
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1023487_EWP_BagbyNettieDeath.jpg
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Is Part Of
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Uncategorized
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Format
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Jpeg Image
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Number
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35eed6dc817f81687d5996a6a3605d7228190aff8b02a72c214d182de67d1c10
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Source
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/Volumes/T7 Shield/EWP/Elements/EWP_Files/Access Files/Upload temp/1023487_EWP_BagbyNettieDeath.jpg
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Publisher
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Digitized by Edwin Washingon Project
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Rights
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Loudoun County Public Schools
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Language
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English
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extracted text
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MARGIN RESERVED FOR BINDING
THIS IS A PERMANENT RECORD. EVERY
ItEm OF InFoRmATION SHOULD BE CAREFULLY SUPFLIED, AGE SHOULD BE STATED EXACTLY. PHYSICIANS
WRITE PLAINLY, WITH UNFADING INK (WRITING FLUID)
N. B.
SHOULD STATE THE CAUSE OF DEATH IN PLAIN TERMS. SO THAT IT MAY BE PROPERLY CLASSIFIED, EXACT
STATEMENT OF OCCUPATION 15 VERY IMPORTANT.
~
~N
128
1 PLACE OF DEATH
County oF
MAGISTERIAL
DISTRICT OF -~
ING. TOWN oF.
VI
e 2 Smna san S
2 FULL NAM
(a) Resipence.
No B 2L (O
N U o f abodey
P A A e e
PERSONAL AND STATISTICAL PARTICULARS
SsEX” |4 CoLom oR RACE
Flowal] oot |
¥ 1+ ngees, Wisewes o BivGREEs
HOSBAND oF
{or) WIFE oF
S SINGLE, MARRIED, WisoWED:
OR DIVORCED (write the word)
[y
& DATE OF BIRTH (Mot bAv, ANG YEAR, WRITE NANE o7 ManTH]
7 AcE Yeams | Monwes | Dav ‘ i ies A
WGW—
5 GENERAL NATURE 07 IOUSTRY.
Wniow surLovea (on ENPLOYER) -
() nans or eurtoven .
BIRTHPLACE|
Cerry on Town).
(srave oncovnrar)
10 NAME OF FATHER
5
O ben e e &
AcE OF FATHER
Cerry on Town). *A)F I
| __(exare o counav)
| 12 MAIDEN NAME OF MOTHER
oS i A
73 BIRTHPLACE OF MoT!
T BIRTH!
PARENTS
(erry or vown)
(s7ate on countay)
" m.mmj_Lm_L.\is.&M_@Mm\
S \‘_,_._.3
(Aooness)
CERTIFICATE OF DEATH
Qs rss’@i> COMMONWEALTH OF VIRGINIA
BureAu or ViaL STaTisTics
S7ATE BoAno or HEALTH
REGISTRATION DISTRICT No.
W 2o S
(f death occured i a hospital o othec nsitution, ive its NAME.
e
23832
RecisTeReD No.
(ron uee o7 Locas =
o ux mazareo uY REGISTRAR)
stead of treet aad number)
Wanro 21U LT
i son-seideat give ciy o fown and Statd)
How lengin U. S, if of forign bink? . mos
&
1 MEDICAL CERTIFICATE OF DEATH /04 ©
| 2
17 | HEREBY CERTIFY, THAT | ATTENDED DECEASED From
L7 126 o 2.2l
7t =
THAT | LasT Saw H=3"ALIvE on. w2l
g e
AN THAT DEATH OCCURED, ON DATE STATED ABOVE. "7’/,;/41
‘ msczazfor DEATHY 1%‘
Sos L 75N
m?muwvw f/%. S
—_ounarion) —_vns._/ _wos
B m@
7'1,-/
Rt o
WHAT TEST CONFIRMED DiagNOSIS?.
(sionee)
/ AD (Aponess) -
%& oy e
T 11 VNS AND NATURE S RTURE i O e K55
DENTAL, SUICIDAL, or HOMICIDAL g 2 e
5 PLACE OF BURIA
MOVAL
i&:&r\;tfigu,
20 UNDERTAKER Jio \
coness | D 1)
- CREMATI
OR RE| DT or BuRiAL
