Death Certificate of Evalina Holland Wyatt

Evalina Holland Wyatt, age 84, died of cardiac failure due to
arteriosclerotic cardiovascular disease with hypertension on 11 Oct 1967
at Hillcrest Nursing Home, Suffolk, Virginia. She was born 17 Mar 1883
in Nansemond Co., daughter of James Solomon Holland and Martha Holland,
widowed spouse of William Jasper Wyatt, and resided at 801 Gittings St.,
Suffolk.

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| Field                                                             | Value                                                       |
|-------------------------------------------------------------------|-------------------------------------------------------------|
| REGISTRATION AREA NUMBER                                          | 227                                                         |
| CERTIFICATE NUMBER                                                | 40                                                          |
| STATE FILE NUMBER                                                 | 67 028433                                                   |
| 1. FULL NAME OF DECEASED                                          | Evalina Holland Wyatt                                       |
| 2. SEX                                                            | Female                                                      |
| 3. COLOR OR RACE                                                  | White                                                       |
| 4. DATE OF DEATH (mo., day, year)                                 | Oct. 11, 1967                                               |
| 5. AGE OF DECEASED                                                | 84 years                                                    |
| 6. NAME OF HOSPITAL OR INSTITUTION OF DEATH (If none, so state)   | Hillcrest Nursing Home                                      |
| 7. CITY OR TOWN OF DEATH                                          | Suffolk                                                     |
| 8. COUNTY OF DEATH                                                | Suffolk                                                     |
| 9. ADDRESS                                                        | 200 W. Constance, Rd.                                       |
| 10. RESIDENCE: STATE                                              | Virginia                                                    |
| 11. RESIDENCE: COUNTY                                             | Suffolk                                                     |
| 12. RESIDENCE (If inside city or town limits)                     | 801 Gittings, St.                                           |
| 13. NAME OF FATHER OF DECEASED                                    | James Solomon Holland                                       |
| 14. MAIDEN NAME OF MOTHER OF DECEASED                             | Martha Holland                                              |
| 15. DECEDENT SERVED IN ARMED FORCES                               | No                                                          |
| 16. DATE OF BIRTH OF DECEDENT                                     | March 17, 1883                                              |
| 17. BIRTHPLACE OF DECEDENT                                        | Nansemond Co.                                               |
| 18. MARITAL STATUS                                                | Widowed                                                     |
| 19. NAME OF SPOUSE                                                | William Jasper Wyatt                                        |
| 20. USUAL OCCUPATION                                              | Housewife Ret.                                              |
| 21. KIND OF BUSINESS OR INDUSTRY                                  | [blank]                                                     |
| 22. INFORMANT OR SOURCE OF INFORMATION                            | Mrs. Peggy S. Bradshaw                                      |
| 23. ADDRESS                                                       | Suffolk, Va.                                                |
| 24a. DATE OF DEATH                                                | 10-11-67                                                    |
| 24b. I CERTIFY THAT I ATTENDED THE DECEASED FROM                  | 2-6-60 TO 10-11-67                                          |
| 24c. LAST SAW ALIVE                                               | 10-11-67                                                    |
| 24d. DEATH OCCURRED AT                                            | 7:30 AM                                                     |
| 25A. IMMEDIATE CAUSE                                              | Cardiac failure                                             |
| 25A. DUE TO (or as a consequence of)                              | Arteriosclerotic cardiovascular disease with hypertension   |
| 25A. INTERVAL BETWEEN ONSET AND DEATH                             | 6 years                                                     |
| 25B. OTHER SIGNIFICANT CONDITIONS                                 | [blank]                                                     |
| 26. AUTOPSY                                                       | No                                                          |
| 27. INJURY                                                        | [not checked]                                               |
| 28. DESCRIBE HOW INJURY OCCURRED                                  | [blank]                                                     |
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| 29. PLACE OF INJURY