Death Certificate of Mary Louise Holland Carr

Mary Louise Holland Carr, 26, died on 15 Feb 1973 in Nansemond from
multiple sustained injuries when struck by car. A resident of Holland,
she was married to Shirley Lee Carr and was buried at Western Branch
Church Centy., Nansemond, Va.

Mrs. Carr died at Obici Memorial Hospital in Nansemond, Virginia, at
9:45 A.M. on 15 Feb 1973 from multiple sustained injuries due to an
accident involving an auto by the roadside. An autopsy was performed.
She was a picker at a peanut plant.

|------------------------------------------------------|----------------------------------------------|
| Field                                                | Value                                        |
|------------------------------------------------------|----------------------------------------------|
| COPY A                                               | FOR BUREAU OF VITAL STATISTICS               |
| REGISTRATION AREA NUMBER                             | 161                                          |
| CERTIFICATE NUMBER                                   | 84                                           |
| STATE FILE NUMBER                                    | 73 006513                                    |
| 1. FULL NAME OF DECEASED                             | Mary Louise Holland Carr                     |
| 2. DATE OF DEATH                                     | February 15, 1973                            |
| 3. AGE OF DECEASED                                   | 26 years                                     |
| 4a. NAME OF HOSPITAL OR INSTITUTION                  | Obici Memorial Hospital                      |
| 4b.                                                  | —                                            |
| 5. CITY OR TOWN OF DEATH                             | Nansemond                                    |
| 6. COUNTY OF DEATH                                   | Nansemond                                    |
| 7. STATE OR FOREIGN COUNTRY OF DEATH                 | Virginia                                     |
| 8. STATE OR FOREIGN COUNTRY                          | Virginia                                     |
| 9. COUNTY OR INDEPENDENT CITY                        | Nansemond                                    |
| 10. CITY OR TOWN                                     | Holland                                      |
| 11. ADDRESS                                          | Rt. 2, Box 92                                |
| 12. ZIP CODE                                         | 23391                                        |
| 13. SEX                                              | Female                                       |
| 14. COLOR OR RACE                                    | White                                        |
| 15. MARITAL STATUS                                   | Married                                      |
| 16. NAME OF SPOUSE                                   | Shirley Lee Carr                             |
| 17. DATE OF BIRTH                                    | January 28, 1947                             |
| 18. AGE                                              | 26 years                                     |
| 19. BIRTHPLACE                                       | Southampton Co.                              |
| 20. FATHER'S NAME                                    | Fenton Holland                               |
| 21. MOTHER'S MAIDEN NAME                             | Mamie Lee Lewis Holland                      |
| 22. USUAL OCCUPATION                                 | Picker                                       |
| 23. KIND OF BUSINESS OR INDUSTRY                     | Peanut Plant                                 |
| 24. SOCIAL SECURITY NUMBER                           | —                                            |
| 25. VETERAN                                          | No                                           |
| 26. DATE OF DEATH                                    | February 15, 1973                            |
| 26a. TIME OF DEATH                                   | 9:45 A.M.                                    |
| 27. DEATH OCCURRED...                                | Signed M. D. McLemore, M.D.                  |
| CAUSE OF DEATH                                       | Multiple sustained injuries                  |
| PART II. OTHER SIGNIFICANT CONDITIONS                | —                                            |
| 28. WAS AUTOPSY PERFORMED?                           | Yes                                          |
| 29. PREGNANCY IN PAST 3 MONTHS?                      | No                                           |
| 30. WAS DEATH DUE TO ACCIDENT, SUICIDE, OR HOMICIDE? | Accident                                     |
| 31. DATE OF INJURY                                   | February 15, 1973                            |
| 31a. HOUR                                            | 9:00 A.M.                                    |
| 31b. PLACE OF INJURY                                 | Auto by roadside                             |
| 31c. OUTSIDE HOME/INSTITUTION                        | -                                            |
| 31d. INJURY AT WORK?                                 | No                                           |
| 31e. CITY OR TOWN                                    | Nansemond                                    |
| 31f. COUNTY                                          | Nansemond                                    |
| 31g. STATE                                           | Va.                                          |
| SIGNATURE & TITLE OF CERTIFYING PHYSICIAN            | Phllip R Nueman, M.D.                        |
| DATE SIGNED                                          | Feb. 16, 1973                                |
| 27. BURIAL, REMOVAL OR CREMATION PERMIT              | Yes                                          |
| 28. DATE OF BURIAL/CREMATION/REMOVAL                 | February 18, 1973                            |
| 29. PLACE OF BURIAL, REMOVAL OR CREMATION            | Western Branch Church Centy., Nansemond, Va. |
| FUNERAL DIRECTOR                                     | I. O Hill & Co., Funeral Home                |
| ADDRESS                                              | —                                            |
| REGISTRAR                                            | Jean C. Dail                                 |
| DATE RECEIVED                                        | 2/21/73                                      |
| Handwritten note                                     | 999                                          |
| Sex checkbox                                         | Female                                       |
| Color or Race checkbox                               | White                                        |
| Marital Status checkbox                              | Married                                      |
| Veteran checkbox                                     | No                                           |
| Was autopsy performed? checkbox                      | Yes                                          |
| Pregnancy last 3 mos.? checkbox                      | No                                           |
| Accident, suicide, or homicide? checkbox             | Accident                                     |
| Injury at work? checkbox                             | No                                           |
|------------------------------------------------------|----------------------------------------------|

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