5/5/1926 LAWRENCE PAYNE’s Death Cert

death cert - front

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