Death Certificate of Lewis, Nathan Tommie

Nathan Tommie Lewis, age 72, died of heart arrest due to heart coronary
occlusion at Louise Obici Memorial Hospital in Suffolk, Nansemond
County, Virginia, on 27 Jun 1971. Born 14 Jul 1898 in Isle of Wight to
Nathan T. Lewis and Sarah Catherine Britt, he was married to Valeria
Boyette Lewis and lived at Rt. 4, Box 599, Suffolk.

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| Field                                              | Value                                                               |
|----------------------------------------------------|---------------------------------------------------------------------|
| REGISTRATION AREA NUMBER                           | 161                                                                 |
| CERTIFICATE NUMBER                                 | 222                                                                 |
| STATE FILE NUMBER                                  | 71 09029                                                            |
| 1. FULL NAME OF DECEDENT                           | Nathan Tommie Lewis                                                 |
| 2. SEX                                             | Male                                                                |
| 3. DATE OF DEATH (Mo., day, yr.)                   | 6-27-71                                                             |
| 4. AGE OF DECEDENT                                 | 72 years                                                            |
| 5. IF UNDER 1 YEAR                                 | (not checked)                                                       |
| 6. IF UNDER 1 DAY                                  | (not checked)                                                       |
| 7. COLOR OR RACE                                   | White                                                               |
| 8. NAME OF HOSPITAL OR INSTITUTION                 | Louise Obici Memorial Hospital                                      |
| 9. COUNTY OF DEATH                                 | Nansemond                                                           |
| 10. CITY OR TOWN                                   | Suffolk                                                             |
| 11. INSIDE CITY OR TOWN LIMITS                     | Yes (checked)                                                       |
| 12. ADDRESS                                        | Smithfield Road                                                     |
| 13. STATE (OR FOREIGN COUNTRY) OF RESIDENCE        | Va.                                                                 |
| 14. COUNTY OF RESIDENCE                            | Nansemond                                                           |
| 15. CITY OR TOWN                                   | Suffolk                                                             |
| 16. ADDRESS                                        | Rt. 4, Box 599                                                      |
| 17. ZIP CODE                                       | 23434                                                               |
| 18. NAME OF FATHER OF DECEASED                     | Nathan T. Lewis                                                     |
| 19. MAIDEN NAME OF MOTHER OF DECEASED              | Sarah Catherine Britt                                               |
| 20. DECEDENT SERVED IN WHICH COUNTRY               | USA                                                                 |
| 21. MARITAL STATUS                                 | Married                                                             |
| 22. NAME OF SPOUSE                                 | Valeria Boyette Lewis                                               |
| 23. USUAL OR LAST OCCUPATION                       | Retired                                                             |
| 24. KIND OF BUSINESS OR INDUSTRY                   | Farmer                                                              |
| 25. INFORMANT OR SOURCE OF INFORMATION             | Mrs. Valeria B. Lewis-Wife                                          |
| 26. BIRTHPLACE OF DECEASED                         | Isle of Wight                                                       |
| 27. DATE OF BIRTH OF DECEASED                      | July 14, 1898                                                       |
| 28a. IMMEDIATE CAUSE (A)                           | Heart arrest                                                        |
| 28b. DUE TO (OR AS A CONSEQUENCE OF)               | Heart coronary occlusion                                            |
| 28c. DUE TO (OR AS A CONSEQUENCE OF)               | (not filled)                                                        |
| 29. INTERVAL BETWEEN ONSET AND DEATH               | Instant                                                             |
| 30. PART II. OTHER SIGNIFICANT CONDITIONS          | Generalized arteriosclerosis, past history of myocardial infarction |
| 31. AUTOPSY                                        | No (checked)                                                        |
| 32. DATE OF INJURY (Mo., day, yr.)                 | (not filled)                                                        |
| 33. PLACE OF INJURY (Specify)                      | (not filled)                                                        |
| 34. DESCRIBE HOW INJURY OCCURRED                   | (not filled)                                                        |
| 26a. I CERTIFY THAT I ATTENDED THE DECEASED FROM   | 6/17/71 TO 6/27/71                                                  |
| 26b. LAST SAW ALIVE                                | 6/27/71                                                             |
| 26c. DEATH OCCURRED AT                             | 5:53 AM                                                             |
| 26d. SIGNATURE                                     | Wm. B. Bryant, M.D.                                                 |
| 26e. DATE SIGNED                                   | 6/27/71                                                             |
| 26f. ADDRESS (CITY AND STATE)                      | Suffolk, Va.                                                        |
| 27a. BURIAL, REMOVAL, CREMATION                    | Burial (checked)                                                    |
| 27b. PLACE                                         | Holly Lawn Cemetery                                                 |
| 27c. LOCATION                                      | Suffolk, Va.                                                        |
| 28. FUNERAL DIRECTOR                               | Sidney Harrell Funeral Home—Suffolk                                 |
| 29. FUNERAL DIRECTOR SIGNATURE                     | Sidney Harrell                                                      |
| 30. REGISTRAR                                      | Jean E. Dail                                                        |
| 31. DATE RECEIVED BY REGISTRAR                     | 7/6/71                                                              |
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