Death Certificate of Anthony Tarbey Mehfoud

Anthony Tarbey Mehfoud, 42, died on 21 Aug 1982 in Quinton from cardio
pulmonary arrest and ulcerative colitis. A resident of New Kent, he
was the widow of Betty Ann Hicks Davis Mehfoud and was buried at Washington 
Memorial Park, Henrico County, Virginia.

Mr. Mehfoud was a male, white, United States citizen, born in Virginia
on 29 Feb 1940 to Anthony P. Mehfoud and Marie O'Grady. He worked as a
teacher in public schools and resided at 5010 Hingham Drive, New Kent,
Virginia, 23124.

|----------------------------------------------------|---------------------------------------|
| Field                                              | Value                                 |
|----------------------------------------------------|---------------------------------------|
| REGISTRATION AREA NUMBER                           | 163                                   |
| CERTIFICATE NUMBER                                 | 13                                    |
| STATE FILE NUMBER                                  | 82-07057                              |
| 1. FULL NAME OF DECEASED                           | Anthony Tarbey Mehfoud                |
| 2. SEX                                             | Male                                  |
| 3. RACE                                            | White                                 |
| 4. DECEDENT Armed Forces?                          | No                                    |
| 5. DATE OF DEATH                                   | Aug. 21, 1982                         |
| 6. AGE                                             | 42                                    |
| 7. DATE OF BIRTH                                   | Feb 29, 1940                          |
| 8. If under 1 year, specify                        | Month ___ Day ___ Hour ___ Minute ___ |
| 9. NAME OF HOSPITAL OR INSTITUTION OF DEATH        | None                                  |
| 10. CITY OR TOWN OF DEATH                          | Quinton                               |
| 11. COUNTY OF DEATH                                | New Kent                              |
| 12. ADDRESS                                        | 5010 Hingham Drive                    |
| 91                                                 | -                                     |
| 163                                                | -                                     |
| 13. RESIDENCE: STATE                               | Virginia                              |
| 14. RESIDENCE: CITY/TOWN                           | New Kent                              |
| 15. ADDRESS                                        | 5010 Hingham Drive                    |
| ZIP CODE                                           | 23124                                 |
| 16. NAME OF FATHER OF DECEASED                     | Anthony P. Mehfoud                    |
| 17. MAIDEN NAME OF MOTHER OF DECEASED              | Marie O'Grady                         |
| 18. CITIZEN OF WHAT COUNTRY?                       | U. S. A.                              |
| 19. BIRTHPLACE                                     | Virginia                              |
| 20. NEVER MARRIED                                  | [ ]                                   |
| 21. MARRIED                                        | [ ]                                   |
| 22. DIVORCED                                       | [ ]                                   |
| 24. WIDOWED                                        | [x]                                   |
| 23. NAME OF SPOUSE                                 | Betty Ann Hicks Davis Mehfoud         |
| 547 2                                              | -                                     |
| USUAL OR LAST OCCUPATION                           | Teacher                               |
| KIND OF BUSINESS OR INDUSTRY                       | Public Schools                        |
| INFORMANT - SIGNATURE OF PERSON SUPPLYING INFO     | Betty Ann Mehfoud                     |
| 26. IMMEDIATE CAUSE OF DEATH                       | CARDIO PULMONARY ARREST               |
| Interval between onset and death                   | ____                                  |
| DUE TO                                             | ULCERATIVE COLITIS                    |
| OTHER SIGNIFICANT CONDITIONS                       | None                                  |
| 27. PREGNANCY IN PAST 3 MONTHS?                    | Yes [ ] No [x] Unknown [ ]            |
| 28. AUTOPSY?                                       | Yes [ ] No [x]                        |
| 29. IF AUTOPSY, WAS IT AUTHORIZED BY               | ___                                   |
| SIGNATURE OF ATTENDING PHYSICIAN                   | Dr. Crawford Smith                    |
| NAME OF ATTENDING PHYSICIAN                        | Dr. Crawford Smith                    |
| ADDRESS OF ATTENDING PHYSICIAN                     | Med. Arts. Bldg. Suite 511            |
| DATE SIGNED                                        | August 23, 1982                       |
| DISPOSITION                                        | Burial [x] Removal [ ] Cremation [ ]  |
| PLACE                                              | Washington Memorial Park              |
| CITY OR COUNTY                                     | Henrico County, Virginia              |
| FUNERAL DIRECTOR NAME                              | Joseph W. Bliley Co.                  |
| ADDRESS                                            | 300 East Marshall Street              |
| REGISTRAR - REGISTRAR SIGNATURE                    | Jean G Anderson                       |
|----------------------------------------------------|---------------------------------------|

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