Death Certificate of Mary Katherine Beale

Mary Katherine Beale, age 77, died of congestive heart failure on 16 Nov
1985 at Autumn Care of Portsmouth, Portsmouth, Virginia. She was born 29
Jan 1908 in the U.S.A. to Seeley Williams and Norah (Unknown). Her
residence was 3610 Winchester Dr., Portsmouth, Virginia. She was married
to Milton L. Beale.

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| Field                                                                             | Value                       |
|-----------------------------------------------------------------------------------|-----------------------------|
| 1. FULL NAME OF DECEASED                                                          | Mary Katherine Beale        |
| 2. DATE OF DEATH (mo.) (day) (yr.)                                                | Nov. 16th, 1985             |
| 3. AGE                                                                            | 77                          |
| 4. IF UNDER 1 YEAR (months) (days)                                                | [blank]                     |
| 5. IF UNDER 1 DAY (hours) (minutes)                                               | [blank]                     |
| 6. DATE OF BIRTH                                                                  | Jan. 29, 1908               |
| 7. SEX                                                                            | F                           |
| 8. RACE                                                                           | Cau.                        |
| 9. WAS DECEDENT EVER IN U.S. ARMED FORCES?                                        | No (checked)                |
| PLACE OF DEATH 10. NAME OF HOSPITAL OR INSTITUTION OR DEATH IF NONE, GIVE ADDRESS | Autumn Care of Portsmouth   |
| 11. TO CITY/TOWN OF DEATH                                                         | Portsmouth                  |
| 12. RESIDENCE: STATE                                                              | Virginia                    |
| 13. RESIDENCE: COUNTY                                                             | Portsmouth                  |
| 14. RESIDENCE: CITY/TOWN                                                          | Portsmouth                  |
| 15. ADDRESS                                                                       | 3610 Winchester Dr.         |
| 16. ZIP CODE                                                                      | 23707                       |
| 17. NAME OF FATHER OF DECEASED                                                    | Seeley Williams             |
| 18. BIRTHPLACE (State or country)                                                 | U.S.A.                      |
| 19. MAIDEN NAME OF MOTHER OF DECEASED                                             | Norah (Unknown)             |
| 20. CITIZEN OF WHAT COUNTRY                                                       | U.S.A.                      |
| 21. USUAL (LAST) OCCUPATION                                                       | Housewife                   |
| 22. KIND OF BUSINESS OR INDUSTRY                                                  | -                           |
| 23. SPOUSE:                                                                       | Milton L. Beale             |
| 24. INFORMANT OR SOURCE OF INFORMATION                                            | Virginia Beale Foster       |
| 25. USUAL RESIDENCE OF DECEDENT                                                   | 220                         |
| 26. CAUSE OF DEATH                                                                | congestive heart failure    |
| 26. CAUSE OF DEATH                                                                | [blank]                     ||
| 26. CAUSE OF DEATH                                                                | [blank]                     ||
| 26. PART II. OTHER SIGNIFICANT CONDITIONS                                         | [blank]                     |
| 26a. INTERVAL BETWEEN ONSET AND DEATH                                             | [blank]                     |
| 27. PREGNANCY IN PAST 3 MONTHS?                                                   | No (checked)                |
| 28. IF EXTERNAL CAUSE                                                             | [blank]                     |
| 29. DESCRIBE HOW INJURY RELATING TO DEATH OCCURRED                                | [blank]                     |
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| 30. PLACE OF INJURY