Death Certificate of Duck, Washington Jackson

Narrative summary of the form data:

Washington Jackson Duck, age 82, was born 13 Feb 1896 in Isle of Wight,
Virginia, to Mills H. Duck and Mary Johnson. He resided in Zuni, Isle
of Wight, VA, and was widowed. He died 24 Sep 1978 in Isle of Wight, VA.
Cause of death was cerebral hemorrhage due to hypertensive
cardiovascular disease.

------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------
| Field                                               | Value                              |
|-----------------------------------------------------|------------------------------------|
| 1. Full Name of Decedent                            | Washington Jackson Duck            |
| 2. Sex                                              | Male                               |
| 3. Race                                             | W                                  |
| 4. Date of Death                                    | 9-24-78                            |
| 5. Age                                              | 82                                 |
| 6. If under 1 year, months                          | [Blank]                            |
| 7. If under 1 day, days                             | [Blank]                            |
| 8. Date of Birth                                    | 2-13-1896                          |
| 9. Was Decedent Married or Widowed?                 | Widowed                            |
| 10. Name of Hospital or Institution of Death        | [Blank]                            |
| 11. County of Death                                 | Isle of Wight                      |
| 12. Place of Death                                  | Zuni                               |
| 13. Usual Residence of Decedent                     | Rt 603                             |
| 14. City or Town of Residence                       | Zuni                               |
| 15. County of Residence                             | Isle of Wight                      |
| 16. State or Country of Decedent's Residence        | VA                                 |
| 17. Street Address or R.F.D. No. of Residence       | Rte 603                            |
| 18. Zip Code                                        | 23898                              |
| 19. Name of Father of Decedent                      | Mills H. Duck                      |
| 20. Birthplace of Father                            | USA                                |
| 21. Maiden Name of Mother of Decedent               | Mary Johnson                       |
| 22. Birthplace of Mother                            | Isle of Wight Co.                  |
| 23. Never Married/Married/Widowed/Divorced          | Widowed                            |
| 24. Name of Spouse                                  | Norvella Duck                      |
| 25. Usual Last Occupation                           | Farmer                             |
| 26. Kind of Business or Industry                    | Retired                            |
| 27. Informant                                       | Joseph J. Duck                     |
| 28. Mailing Address of Informant                    | Rte 603, Zuni, VA 23898            |
| 29. Cause of Death (Immediate Cause)                | Cerebral Hemorrhage                |
| 30. Due to (Underlying Cause)                       | Hypertensive cardiovasculardisease |
| 31. Other Significant Conditions                    | [Blank]                            |
| 32. Autopsy                                         | No                                 |
| 33. If Female, Was There a Pregnancy                | [Blank]                            |
| 34. If External Cause, it was:                      | [Blank]                            |
| 35. Describe How Injury Relating to Death Occurred  | [Blank]                            |
| 36. Injury Occurred                                 | [Blank]                            |
| 37. Place Injury Occurred                           | [Blank]                            |
| 38. Natural Cause/Accident/Suicide/Homicide/Pending | Natural Cause                      |
| 39. Actual or Presumed Time of Death                | 10:00 AM                           |
| 40. Date Pronounced Dead                            | 9-24-78                            |
| 41. Name of Medical Examiner                        | D. Wayne Lundie                    |
| 42. Signature of Medical Examiner                   | D. Wayne Lundie                    |
| 43. Date Signed by Medical Examiner                 | 9-25-78                            |
| 44. Place of Burial, Removal, Cremation             | Cedar Hill                         |
| 45. City or County                                  | Suffolk, VA                        |
| 46. Funeral Director                                | Purviance Funeral Home             |
| 47. Address of Funeral Director                     | NC, Wakefield, VA 23888            |
| 48. Signature of Funeral Director                   | [Signature]                        |
| 49. Registrar                                       | Linda H. Willis                    |
| 50. Date Record Filed                               | 23 Oct 1978                        |
| 51. State File Number                               | 78 031643                          |
| 52. Registration Area Number                        | 146                                |
| 53. Certificate Number                              | 42                                 |
| 54. Personal Data of Decedent                       | 547 3                              |
--------------------------------------------------------------------------------------------