Death Certificate of William Jasper Wyatt

William Jasper Wyatt, age 81, died of coronary occlusion on 1 Aug 1964
in Suffolk, Nansemond County, Virginia. He resided at 801 Gittings St.,
Suffolk, and was born 2 Sep 1882 in Nansemond County to J. I. Wyatt and
Polly Holland. He was married to Eveline Holland Wyatt and worked as a
railroad conductor. Burial took place at Cedar Hill, Suffolk.

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| Field                                                              | Value                                                     |
|--------------------------------------------------------------------|-----------------------------------------------------------|
| PLACE OF DEATH 1. FULL NAME OF DECEASED                            | William Jasper Wyatt                                      |
| 2. DATE OF DEATH (Mo., Day, Yr.)                                   | August 1 1964                                             |
| 3. AGE OF DECEASED                                                 | 81                                                        |
| 4. UNDER 1 YEAR                                                    | [] Under 1 Day, [] Under 1 Month, [] 1-11 Months          |
| 5. COLOR OR RACE                                                   | White                                                     |
| 6. SEX                                                             | Male                                                      |
| 7. NAME OF HOSPITAL OR INSTITUTION OF DEATH (If none, so state)    | none                                                      |
| 8. COUNTY OF DEATH (If independent city, leave blank)              | Nansemond                                                 |
| 9. CITY OR TOWN OF DEATH                                           | Suffolk                                                   |
| 10. (Inside city or town limits)                                   | [X] Yes | [] No                                           |
| 11. ADDRESS                                                        | 801 Gittings, St.                                         |
| USUAL RESIDENCE 12. RESIDENCE: STATE                               | Virginia                                                  |
| 13. RESIDENCE: COUNTY                                              | Nansemond                                                 |
| 14. RESIDENCE: CITY/TOWN                                           | Suffolk                                                   |
| 15. (Inside city or town limits)                                   | [X] Yes | [] No                                           |
| 16. ADDRESS                                                        | 801 Gittings, St.                                         |
| PERSONAL DATA OF DECEASED 14. NAME OF FATHER OF DECEASED           | J. I. Wyatt                                               |
| 15. MAIDEN NAME OF MOTHER OF DECEASED                              | Polly Holland                                             |
| 16. CITIZENSHIP                                                    | U.S.A.                                                    |
| 17. MARITAL STATUS                                                 | [X] Married | [] Never Married | [] Widowed | [] Divorced |
| 18. NAME OF SPOUSE                                                 | Eveline Holland Wyatt                                     |
| 19. BIRTHPLACE OF DECEASED                                         | Nansemond Co., Va.                                        |
| 20. DATE OF BIRTH OF DECEASED                                      | Sept. 2 1882                                              |
| 21. USUAL (OR LAST) OCCUPATION                                     | Conductor Railroad                                        |
| 22. KIND OF BUSINESS OR INDUSTRY                                   | ---                                                       |
| 23. NAME & ADDRESS OF INFORMANT                                    | Mrs. Charles Bradshaw, Suffolk, Va.                       |
| MEDICAL CERTIFICATION 26. CAUSE OF DEATH                           |                                                           |
| a. IMMEDIATE CAUSE (A)                                             | Coronary Occlusion                                        |
| INTERVAL BETWEEN ONSET AND DEATH                                   | 2 days                                                    |
| b. DUE TO:                                                         |                                                           |
| c. DUE TO:                                                         |                                                           |
| d. DUE TO:                                                         |                                                           |
| 28. PART II: OTHER SIGNIFICANT CONDITIONS                          | [red ink: 4201]                                           |
| 29. PREGNANCY IN PAST 3 MONTHS?                                    | [] Yes | [] No | [X] Unknown                              |
| 30. AUTOPSY                                                        | [] Yes | [X] No                                           |
| 31. SIGNATURE OF PHYSICIAN                                         | B. L. Holloday M.D.                                       |
| 32. DATE SIGNED                                                    | 8-1-64                                                    |
| 33. ADDRESS                                                        | Suffolk, Va.                                              |
| 34. DATE OF DEATH                                                  | 8-1-64                                                    |
| 35. HOUR OF DEATH                                                  | 8:55 A.M.                                                 |
| 36. BURIAL, REMOVAL, CREMATION, PLACE                              | Cedar Hill, Suffolk, Virginia                             |
| 37. FUNERAL DIRECTOR SIGNATURE                                     | I. O. Hill                                                |
| 38. NAME OF FUNERAL HOME                                           | I. O. Hill & Co.                                          |
| 39. ADDRESS                                                        | Suffolk, Va.                                              |
| 40. REGISTRAR                                                      | Esther L. Harrell                                         |
| 41. DATE RECEIVED                                                  | 8-3-64                                                    |
| Other markings: COPY 1                                             |                                                           |
| CERTIFICATE NUMBER                                                 | 229                                                       |
| STATE FILE NUMBER                                                  | 23558                                                     |
| REGISTRATION AREA NUMBER                                           | 227                                                       |
| Funeral Director Permit Number                                     | 30181                                                     |
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