Death Certificate of Brett, Mary E

Mary E. Brett, age 75, was born on 23 Mar 1855 in Southampton, VA to
Dempsey Johnson and Mediana Matthews. She was a widow, spouse of G. E,
Brett, and resided in Suffolk, VA. She died of senile dementia on 22 Feb
1930 in Nansemond, VA.

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| Field                                                             | Value                |
|-------------------------------------------------------------------|----------------------|
| 1. PLACE OF DEATH                                                 | Nansemond            |
| COUNTY OF                                                         | Nansemond            |
| TOWN, CITY OR MAGISTERIAL DISTRICT OF                             | Suffolk, VA          |
| 2. FULL NAME                                                      | Mary E. Brett        |
| (A) RESIDENCE                                                                            |
| 3. SEX                                                            | Female               |
| 4. COLOR OR RACE                                                  | White                |
| 5. SINGLE, MARRIED, WIDOWED, OR DIVORCED                          | Widow                |
| 6. IF MARRIED, WIDOWED, OR DIVORCED, HUSBAND OF                   | G. E. Brett          |
| 7. DATE OF BIRTH                                                  | Mar. 8, 1855         |
| 8. AGE                                                            | 75 10 23             |
| 9. TRADE, PROFESSION, OR PARTICULAR KIND OF WORK                  | Housewife            |
| 10. INDUSTRY OR BUSINESS IN WHICH WORKED                          |                      |
| 11. DATE DECEASED LAST WORKED AT THIS OCCUPATION                  |                      |
| 12. BIRTHPLACE (city or town)                                     | Southampton          |
| (State or country)                                                | Va                   |
| 13. FATHER'S NAME                                                 | Dempsey Johnson      |
| 14. BIRTHPLACE (city or town)                                     | Va                   |
| 15. MOTHER'S MAIDEN NAME                                          | Mediana Matthews     |
| 16. BIRTHPLACE (city or town)                                     | Va                   |
| 17. INFORMANT                                                     | L. L. Brett          |
|| (ADDRESS)                                                        | Suffolk, VA          |
| 18. BURIAL, CREMATION, OR REMOVAL                                 | Holland Cemetery     |
| (PLACE)                                                           | Holland, VA          |
| DATE OF BURIAL                                                    | Jan. 27, 1931        |
| 19. UNDERTAKER                                                    | W. H. Holland & Sons |
|| (ADDRESS)                                                        | Suffolk, VA          |
| 20. FILED                                                         | Jan. 27, 1931        |
| BY                                                                | W. J. Moore          |
| 21. DATE OF DEATH                                                 | 2/22/1930            |
| 22. I HEREBY CERTIFY...                                           | 2/22/1930            |
| 23. THE PRINCIPAL CAUSE OF DEATH                                  | Senile dementia      |
| DURATION                                                          | 10 days              |
| CONTRIBUTORY CAUSE OF IMPORTANCE NOT RELATED TO PRINCIPALCAUSE    | General weakness     |
| NAME OF OPERATION                                                                        |
| DATE OF OPERATION                                                                        |
| WHAT TEST CONFIRMED DIAGNOSIS                                                            |
| WAS THERE AN AUTOPSY?                                                                    |
| 24. IF DEATH WAS DUE TO EXTERNAL CAUSES...                                               |
| ACCIDENT, SUICIDE, OR HOMICIDE?                                                          |
| WHERE DID INJURY OCCUR?                                                                  |
| MANNER OF INJURY                                                                         |
| WAS DISEASE OR INJURY IN ANY WAY RELATED TO OCCUPATION OFDECEASED                        |
| IF SO, SPECIFY                                                                           |
| SIGNED                                                            | J. H. Rawls, M.D.    |
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