Death Certificate of Matthew James Owens, Sr.

Matthew James Owens, Sr., age 56, died of cardiac paniklosis at his
residence, 1309 Chewink Court, Virginia Beach, on 27 Dec 1978. Born 6
Mar 1922 in Virginia to Harley Robert Owens and Allie Starnes, he was
married to Anne Bradshaw Owens. He lived at the same address and was
buried at Princess Anne Memorial Park, Virginia Beach.

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| Field                                                 | Value                                           |
|-------------------------------------------------------|-------------------------------------------------|
| 1. FULL NAME OF DECEASED                              | Matthew James Owens, Sr.                        |
| 2. SEX                                                | M                                               |
| 3. RACE                                               | White                                           |
| 4. DATE OF DEATH (mo., day, yr.)                      | December 27, 1978                               |
| 5. AGE                                                | 56                                              |
| 6. IF UNDER 1 YEAR                                    | (This section is not filled out)                |
| 7. IF UNDER 1 DAY                                     | (This section is not filled out)                |
| 8. DATE OF BIRTH (mo., day, yr.)                      | March 6, 1922                                   |
| 9. WAS DECEDENT EVER IN U.S. ARMED FORCES?            | X (Checked Yes)                                 |
| 10. PLACE OF DEATH                                    | Residence                                       |
| 11. NAME OF PLACE OF DEATH                            | 1309 Chewink Court                              |
| 12. CITY OR TOWN OF DEATH                             | Virginia Beach                                  |
| 13. COUNTY OF DEATH                                   |                                                 |
| 14. RESIDENCE: STATE                                  | Virginia                                        |
| 15. RESIDENCE: CITY/TOWN                              | Virginia Beach                                  |
| 16. ADDRESS                                           | 1309 Chewink Court                              |
| 17. ZIP CODE                                          | 23451                                           |
| 18. CITIZEN OF WHAT COUNTRY?                          | USA                                             |
| 547_2. NAME OF FATHER OF DECEASED                     | Harley Robert Owens                             |
| 547_2. MAIDEN NAME OF MOTHER OF DECEASED              | Allie Starnes                                   |
| 19. USUAL OCCUPATION                                  | Adm. Asst.                                      |
| 20. KIND OF BUSINESS OR INDUSTRY                      | Holmes Convalescent Home                        |
| 21. BIRTHPLACE (State or Foreign Country)             | Virginia                                        |
| 22. MARITAL STATUS                                    | X Married (box checked)                         |
| 23. NAME OF SPOUSE                                    | Anne Bradshaw Owens                             |
| 24. TO PHYSICIAN                                      | (Text in handwriting): 11:25                    |
| 25. IMMEDIATE CAUSE (A)                               | CARDIAC PANICLOSIS                              |
| Interval Between Onset and Death                      | 5 Mo.                                           |
| 26a. AUTOPSY?                                         | No (box checked)                                |
| 26b. WAS DEATH CAUSED BY INJURY?                      | No (box checked)                                |
| 26c. DESCRIBE HOW INJURY RELATING TO DEATH OCCURRED   | (blank)                                         |
| PART II                                               | (No information provided in this section.)      |
| I certify that death occurred at                      | 11:25 (p.m. [checked])                          |
| Date and place and from the cause(s) stated           | 12-29-78                                        |
| Signature (physician)                                 | James P. Charlton MD                            |
| Address of Attending Physician                        | 1120 First Colonial Rd.                         |
| 27. BURIAL                                            | Princess Anne Memorial Park, Virginia Beach, VA |
| Date                                                  | 12-30-78                                        |
| FUNERAL DIRECTOR                                      | Mike Penney                                     |
| NAME OF FUNERAL HOME                                  | H.D. Oliver Funeral Apts., Inc.                 |
| DATE RECORDED                                         | 1-2-79                                          |
| REGISTRAR SIGNATURE                                   | Edna K. Lamorelle                               |
| REGISTRATION NUMBER                                   | 78 039202                                       |
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