Death Certificate of Mary Frances Wood

Mary Frances Wood, 67, died on 16 Aug 1997 in Portsmouth from metastatic
adenocarcinoma breast due  TO skin, pleura possibly lungs. A resident of
Chesapeake, she was married to Johnnie L. Wood and was buried on 19 Aug
1997 at Olive Branch Cemetery.

Mrs. Wood was born on 12 Sep 1929 in Virginia to Bennie Powell and
Virginia Underwood. She was Caucasian, a U.S. citizen, school teacher in
elementary education, widowed, and resided at 3636 High Street,
Chesapeake, Virginia.

|-----------------------------------|--------------------------------------------|
| Field                             | Value                                      |
|-----------------------------------|--------------------------------------------|
| Registration Area Number          | 220                                        |
| Certificate Number                | 0854                                       |
| State File Number                 | 97-034060                                  |
| 1. FULL NAME OF DECEDENT          | MARY FRANCES WOOD                          |
| 2. SEX                            | F                                          |
| 3. DATE OF DEATH                  | August 16, 1997                            |
| 4. AGE                            | 67                                         |
| 5. DATE OF BIRTH                  | Sept. 12, 1929                             |
| 6. WAS DECEDENT EVER IN U.S.      | [ | ] YES [ X ] NO                          |
| ARMED FORCES                      | -                                          |
| 7. HOSPITAL OR OTHER INSTITUTION  | Maryview Medical Center                    |
| 8. CITY OR TOWN OF DEATH          | Portsmouth                                 |
| 9. COUNTY OF DEATH                | [blank]                                    |
| 10. LOCAL FILE NUMBER             | [blank]                                    |
| 11. RESIDENCE: STATE              | Virginia                                   |
| 12. USUAL RESIDENCE OF DECEDENT   | 3636 High Street                           |
| 13. RESIDENCE: CITY/TOWN          | Chesapeake                                 |
| 14. RESIDENCE: COUNTY             | [blank]                                    |
| 15. RESIDENCE: STATE              | Virginia                                   |
| 16. ZIP CODE                      | 23323                                      |
| 17. NAME OF DECEDENT'S FATHER     | Bennie Powell                              |
| 18. MAIDEN NAME OF DECEDENT'S     | Virginia Underwood                         |
| MOTHER                            | -                                          |
| 19. RACE                          | Cauc.                                      |
| 20. CITIZEN OF WHAT COUNTRY       | U.S.A.                                     |
| 21. BIRTHPLACE                    | Virginia                                   |
| 22. EDUCATION                     | 4                                          |
| 23. USUAL OCCUPATION              | School Teacher                             |
| 24. KIND OF BUSINESS OR INDUSTRY  | Elementary                                 |
| 25. MARITAL STATUS                | Widowed                                    |
| 26. NAME OF SURVIVING SPOUSE      | Johnnie L. Wood                            |
| 26a. SURVIVING SPOUSE'S MAIDEN    | [blank]                                    |
| NAME                              | -                                          |
| 27. SOCIAL SECURITY NUMBER        | [redacted in image]                        |
| 28. INFORMANT                     | City of Chesapeake, Husband                |
| 29. IMMEDIATE CAUSE               | METASTATIC ADENOCARCINOMA BREAST           |
| 29. DUE TO OR AS A CONSEQUENCE OF | TO SKIN, PLEURA, POSSIBLY LUNGS            |
| 29. DUE TO OR AS A CONSEQUENCE OF | POSSIBLE PULMONARY EMBOLUS                 |
| 29. INTERVAL BETWEEN ONSET AND    | ~8 months / hours                          |
| DEATH                             | -                                          |
| PART II. OTHER SIGNIFICANT        | [blank]                                    |
| CONDITIONS                        | -                                          |
| 30. DATE OF INJURY                | [blank]                                    |
| 31. PLACE OF INJURY               | [blank]                                    |
| 32. INJURY AT WORK                | [ ] YES [ ] NO                             |
| 33. HOW INJURY OCCURRED           | [blank]                                    |
| 34. PREGNANCY IN PAST 3 MONTHS?   | [ ] YES [ ] NO                             |
| 35. AUTOPSY                       | [ ] YES [ x ] NO                           |
| 36. WAS CASE REFERRED TO          | [ ] YES [ x ] NO                           |
| MEDICAL EXAMINER                  | -                                          |
| 38. TIME OF DEATH                 | 7:20                                       |
| 38. SIGNATURE                     | [signed]                                   |
| 38. DATE SIGNED                   | 8/18/97                                    |
| 40. PRINTED NAME OF ATTENDING     | Daniel R. Atienza, M.D.                    |
| 41. ADDRESS OF ATTENDING          | 4053 Taylor Road, Chesapeake, VA           |
| 42. FUNERAL DIRECTOR              | [signature]                                |
| 43. REMOVAL OR CREMATION          | ☒ Burial ☐ Removal ☐ Cremation             |
| 43. PLACE                         | Olive Branch Cemetery                      |
| 44. NAME AND ADDRESS OF FUNERAL   | Sturtevant Funeral Home, Inc., Portsmouth, |
| HOME                              | Virginia                                   |
| 45. REGISTRAR SIGNATURE           | [signature]                                |
| 46. DATE RECEIVED                 | AUG 1 9 1997                               |
|-----------------------------------|--------------------------------------------|

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