Certificate of Death
Commonwealth of Virginia
Bureau of Vital Statistics
State Board of Health
#11956
Place of Death
Country of: Fredrick
Magisterial District of: Stonewall
Registration District No: 3416
Registered No: 2
Full Name
Lawrence R. Payne
Personal Statistics and Particulars
Sex: M
Color or Race: White
Single, Married, Widowed or Divorced: Widowed
If Married, Widowed or Divorced Husband of: [illegible]
Date of Birth: Aug. 23 1847
Age: 78 years, 8 months. 13 days
Occupation of the Deceased: Merchant
Employer: Retired
Birthplace: Fred. — Va
Name of Father: Joseph Payne
Birthplace of Father: Berk. — W Va
Maiden Name of Mother: Sarah Payne
Birthplace of Mother: Berk. — W Va
Informant: Mr. L. E. Ridgeway
Address: Ridgeway W Va
Filed: May 11, 1926
Registrar: Eugene H. Anderson
Medical Certificate of Death
Date of Death: May 6, 1926
I hereby certify that I attended the deceased from: May 4, 1926 to May 6, 1926 that by law I saw Him alive on May 6, 1926 and that death occurred on the date above, at 9 A m.
The cause of death was as follows: — Pneumonia
Duration: 3 Ds.
Where was disease contracted if not in place of death: In home
Was there an autopsy: No
What test confirmed diagnosis: None
Signed: M. G. Hoffman
May 6, 1926 Address: Bunker Hill, W Va
Place of Burial: Payne’s Chapel W Va 5/8/26
Undertaker: W. O. —
Address: Winchester Va