| Registration Area Number. 220 |
Certificate Number 899 |
| 1. Full Name of Deceased.
Havannah Fred HONEYCUTT |
2. Sex. Male |
| 3. Date of Death.
Oct. 4, 1964 |
4. Age of Deceased.
63 Years
5. Color or Race.
White |
| 6. Name of Hospital Or Instution of Death.
Portsmouth, General |
7. County of Death.
(Blank) |
| 8. City or Town Of Death.
Portsmouth, Inside City Limits |
9. Street Address or Rt. No. of Place Death.
900 Leckie St. |
| 10. State (or Foreign Country) of Deceased's Residence.
Virginia |
11. County of Deceased's Residence
(Blank) |
| 12. City or Town Of Residence.
Portsmouth, Inside City Limits |
13. Street Address or Rt. No. of Residence.
1918 Atlanta Ave. |
| 14. Name of Father of Deceased.
Adam HONEYCUTT |
15. Maiden Name of Mother of
Deceased.
Hattie OVERCASH |
| 16. Deceased Citizen Of What Country.
USA |
17. Married
18. If Married Or Widowed
Name of Spouse.
Edna Thomas HONEYCUTT |
| 19. Social Security Number
(Not listed) |
20. If Veteran name was, or if peacetime only, so state.
(Blank) |
| 21. Birthplace of Deceased (state or country)
North Carolina |
22. Date of Birth of Deceased.
Oct. 27, 1900 |
| 23. Usual or Last Occupation.
Ret. Inspector
24. Kind of Business or Industry.
N.N.S.Y. |
25. Informant - Or Source of Information
Edna T. HONEYCUT |
| 26. Cause of Death.
Part 1 Death was caused by
Immediate Cause (A) Coronary Thrombosis |
Interval Between Onset and Death.
9-25 and 10-4-1964 |
| Conditions if any, which gave rise to immediate cause (A), stating
the underlying cause last.
Due to (C) Hiatal Hernia |
Interval Between Onset and Death.
2 yrs. |
| Part II: Other Significant Conditions Contributing to Death But Not
Related To The Terminal Disease Condition Given in Part 1 (A)
(Blank) |
26a. Autopsy?
No |
| 26b. If Female, Was There A Pregancy In Past 3 Months?
(Blank) |
26c. If External Cause. It was
Primary {} or
Contributing {}
To Cause of Death.
Note if External Cause Notify Med. Examiner.
(Blank) |
| 26d. Describe How Injury Occurred.
(Blank) |
26e. Time of Injury.
(Blank) |
| 26f. Injury Occured.
while at work {} not while at work {}
(Blank) |
26h. (city or town) (county) (state)
(Blank) |
| 26I. I Certify that I attended the deceased from
September 18 - 10-4-64 and that death occured at 4:20 AM |
Signature. KW Howard M.D. Portsmouth, VA.
Date Signed.
10-6-64 |
| 27. Burial |
28. Place Of Burial Removal, Etc.
Oak Grove
(city or county) (state)
Portsmouth, Va. |
| 29. (signature of funeral director or person acting as such)
W.B. JERNIGAN, Sr. |
Name of Funeral Home And Address.
Snellings Funeral Home
Portsmouth, Va. |
| 30. (signature of registrar)
Ha??? D. WILKENS |
Date Record Filed.
10-7-64 |
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