Death Certificate of Ann Ernestine Brett

Ann Ernestine Brett, age 61, died of metastatic lung cancer on 18 Aug
1991 at Chippenham Medical Center, Richmond, Virginia. She was born 4
Aug 1930 in Suffolk, Virginia, to Ernest Gilmore and Ann Bradshaw. She
was married to Walter R. Brett and resided at 121 Wildwood Boulevard,
Ashland, Virginia. Diabetes mellitus contributed to her death.

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| Field                                            | Value                                                  |
|--------------------------------------------------|--------------------------------------------------------|
| REGISTRATION AREA NUMBER                         | 222                                                    |
| CERTIFICATE NUMBER                               | 2632                                                   |
| STATE FILE NUMBER                                | 91-030662                                              |
| 1. NAME OF DECEDENT                              | ANN ERNESTINE BRETT                                    |
| 2. SEX                                           | Female                                                 |
| 3. DATE OF DEATH (Mo, Day, Yr)                   | AUGUST 18, 1991                                        |
| 4. AGE                                           | 61                                                     |
| 5. IF UNDER 1 YEAR                               | (Blank)                                                |
| 6. IF UNDER 1 DAY                                | (Blank)                                                |
| 7. DATE OF BIRTH (Mo, Day, Yr)                   | AUG. 4, 1930                                           |
| 8. WAS DECEDENT EVER IN U.S. ARMED FORCES?       | No (box checked)                                       |
| 9. NAME OF HOSPITAL OR INSTITUTION OF DEATH      | CHIPPEHAM MEDICAL CENTER                               |
| 10. CITY OR TOWN OF DEATH                        | RICHMOND                                               |
| 11. COUNTY OF DEATH                              | (Blank)                                                |
| 12. ADDRESS                                      | 7101 JAHNKE ROAD                                       |
| 13. RESIDENCE: STATE                             | VIRGINIA                                               |
| 14. RESIDENCE: COUNTY                            | HANOVER                                                |
| 15. RESIDENCE: CITY/TOWN                         | ASHLAND                                                |
| 16. ADDRESS                                      | 121 WILDWOOD BOULEVARD                                 |
| ZIP CODE                                         | 23005                                                  |
| 17. NAME OF DECEDENT'S FATHER                    | ERNEST GILMORE                                         |
| 18. MAIDEN NAME OF DECEDENT'S MOTHER             | ANN BRADSHAW                                           |
| 19. RACE OF DECEDENT                             | CAU.                                                   |
| 20. CITIZEN OF WHAT COUNTRY                      | U.S.A.                                                 |
| 21. BIRTHPLACE (State or country)                | SUFFOLK, VA.                                           |
| 22. NEVER MARRIED                                | (Blank)                                                |
| 23. USUAL (OR LAST) OCCUPATION                   | HOMEMAKER                                              |
| 24. KIND OF BUSINESS OR INDUSTRY                 | (Blank)                                                |
| 25. EDUCATION (Specify highest grade completed)  | College (4-5) (box checked)                            |
| 26. MARRIED, DIVORCED, WIDOWED                   | MARRIED (box checked)                                  |
| 27. INFORMANT - SIGNATURE                        | WALTER R. BRETT                                        |
| 28. INFORMANT - ADDRESS                          | 121 WILDWOOD BOULEVARD                                 |
| PART I. IMMEDIATE CAUSE                          | Metastatic Lung Cancer                                 |
| DUE TO (OR AS A CONSEQUENCE OF)                  | (Blank)                                                |
| PART II. OTHER SIGNIFICANT CONDITIONS            | Diabetes Mellitus                                      |
| AUTOPSY?                                         | No (box checked)                                       |
| DATE OF CERTIFICATION                            | 8/26/91                                                |
| SIGNATURE OF ATTENDING PHYSICIAN                 | James P. Wigand, M.D.                                  |
| ADDRESS OF ATTENDING PHYSICIAN                   | 7157 JAHNKE ROAD, RICHMOND, VIRGINIA                   |
| BURIAL                                           | (Box checked)                                          |
| REMOVAL                                          | (Blank)                                                |
| CREMATION                                        | (Blank)                                                |
| PLACE                                            | FOREST GROVE UNITED METHODIST CEMETERY, ASHLAND, VA.   |
| NAME OF FUNERAL HOME AND ADDRESS                 | REID FUNERAL HOME, INC.| P.O. BOX 930, ASHLAND, VA.    |
| FUNERAL DIRECTOR SIGNATURE                       | (Signature present)                                    |
| DATE RECEIVED BY REGISTRAR                       | 8-20-91                                                |
| REGISTRAR                                        | (Signature present)                                    |
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