| Dist. No. | 210 |
|---|---|
| Serial No. | 222 |
| Place of Death | |
| County | Lewis |
| Magisterial District | Court House |
| City or Town | Weston State Hospital |
| Length of stay in hospital or inst. | 12 Days |
| Home (Usual Residence) of Deceased | |
| State | W. Va. |
| County | Jefferson |
| City or Town | Millville |
| Street No. | |
| — | |
| Full Name | Pauline Virginia Webb |
| If veteran, name war | |
| Social Security No. | |
| Sex | Female |
| Color or race | White |
| Single, married, widowed, or divorced. | Single |
| Name of husband or wife | |
| If alive, give age | |
| Birth date of deceased | Sept. 15, 1909 |
| Age | 35 yrs. 2 ms. 28 ds. |
| Birthplace | Millville, Jefferson Co., W. Va. |
| Usual Occupation | Housework |
| [Father’s] Name | Charles Samuel Webb |
| [Father’s] Birthplace | Harpers Ferry, W. Va. |
| [Mother’s] Name | Mary Etta Wedler |
| [Mother’s] Birthplace | Loudoun County, Virginia |
| Informant’s Signature | Hospital Records |
| [Informant’s] Address | Weston State Hospital |
| Burial, Cremation, Removal | Burial |
| Date Thereof | 12 – 16 – 44 |
| Cemetery | |
| Location | Millville, WVa |
| Funeral Director | J. L. Eackles |
| Address | Harpers Ferry, WVa |
| Medical Certification | |
| Date of Death | Dec. 13, 1944 at 1:45PM |
| I certify that death occurred on the date above stated; that I attended deceased from 12/2, 1944 to 12/13, 1944 and that I last saw her alive on 12/13, 1944. | |
| Immediate cause of death | Status Epilepticus |
| Due To | Epilepsy |
| Duration | 2 Days |
| Signature | Harry A. Garrison, M.D. |
| Address | State Hospital Weston, W. Va. 12/13/44 |