Death Certificate of Harris, Mattie Bradshaw

Mattie Bradshaw Harris, age 68, was born on 15 Oct 1864 in Southampton
Co., Virginia, to William Bradshaw and Susan Mangum. She was widowed,
her spouse was James J. Harris. She died on 21 Jan 1951 at Raiford
Memorial Hospital, Franklin, Virginia, from congestive heart failure due
to arteriosclerotic heart disease. Her residence was 702 High Street,
Franklin, Virginia.

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| Field                                       | Value                          |
|---------------------------------------------|--------------------------------|
| 1. COUNTY                                   | Southampton                    |
| 1. DISTRICT NO.                             | 574                            |
| 2. CITY OR TOWN                             | Franklin, Virginia             |
| 2a. INSIDE/OUTSIDE LIMITS                   | Inside                         |
| 2b. HOSPITAL OR INSTITUTION                 | Raiford Memorial Hospital      |
| 3. NAME OF DECEASED (First, Middle, Last)   | Mattie Bradshaw Harris         |
| 4. DATE OF DEATH                            | Jan. 21, 1951                  |
| 5. SEX                                      | Female                         |
| 6. COLOR OR RACE                            | White                          |
| 7. MARITAL STATUS                           | Widowed                        |
| 8. DATE OF BIRTH                            | Oct. 15, 1864                  |
| 9. AGE                                      | 68 years                       |
| 10a. USUAL OCCUPATION                       | Housewife                      |
| 10b. KIND OF BUSINESS OR INDUSTRY           | [Blank]                        |
| 11. BIRTHPLACE (State or country)           | Southampton Co.                |
| 12. CITIZEN OF WHAT COUNTRY                 | Am.                            |
| 13. FATHER'S NAME                           | William Bradshaw               |
| 14. MOTHER'S MAIDEN NAME                    | Susan Mangum                   |
| 15. NAME OF HUSBAND OR WIFE OF DECEASED     | James J. Harris                |
| 17. INFORMANT'S SIGNATURE                   | Miss Mammie Harris             |
| 18. USUAL RESIDENCE (State)                 | Virginia                       |
| 18. COUNTY                                  | Southampton                    |
| 18. CITY OR TOWN                            | Franklin                       |
| 18. INSIDE/OUTSIDE LIMITS                   | Inside                         |
| 18. STREET AND NUMBER                       | 702 High Street                |
| 19. CAUSE OF DEATH (Disease or condition)   | Congestive Heart Failure       |
| 19. DUE TO (Antecedent Causes)              | Arteriosclerotic Heart disease |
| 19. INTERVAL BETWEEN ONSET AND DEATH        | 1 week                         |
| 21. ACCIDENT, SUICIDE, HOMICIDE             | [Blank]                        |
| 21b. PLACE OF INJURY                        | [Blank]                        |
| 21c. INJURY OCCURRED (At home, farm, etc.)  | [Blank]                        |
| 21d. INJURY OCCURRED (At work)              | [Blank]                        |
| 21e. HOW DID INJURY OCCUR                   | [Blank]                        |
| 22. I HEREBY CERTIFY...                     | LH. L. Gardner, M.D.           |
| 23a. ADDRESS (Physician)                    | Franklin                       |
| 23b. DATE SIGNED (Physician)                | Jan. 26, 1951                  |
| 24a. BURIAL, CREMATION, REMOVAL             | Burial                         |
| 24b. DATE                                   | Jan. 23, 1951                  |
| 24c. NAME OF CEMETERY OR CREMATORY          | Poplar Spring                  |
| 24d. LOCATION                               | Franklin, Va.                  |
| 25. FUNERAL DIRECTOR'S SIGNATURE            | W.J.M. Holland & Sons, Inc     |
| 25. ADDRESS (Funeral Director)              | Franklin, Virginia             |
| DATE RECEIVED BY LOCAL REGISTRAR            | January 29, 1951               |
| REGISTRAR'S SIGNATURE                       | Vera Jo Cook                   |
| STATE FILE NO.                              | 2290                           |
| REGISTERED NO.                              | 9                              |
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