Death Certificate of INFANT BOY STEPHENS

Infant Boy Stephens, age 10 hours, died on 16 Apr 1961 in Portsmouth
from prematurity due to unknown causes. A resident of Portsmouth, he was
never married and was buried on 17 Apr 1961 at Greenlawn Memorial Park,
Chesapeake, Virginia.

He infant was the son of Ronald D. Stephens and Irene Ashley, born in
Portsmouth, Virginia, on 15 Apr 1961. He was white, a U.S. citizen, and
never married. He died at Maryview Hospital in Norfolk County, with no
autopsy performed.

|------------------------------------------------|--------------------------------------------------------|
| Field                                          | Value                                                  |
|------------------------------------------------|--------------------------------------------------------|
| REGISTRATION AREA NUMBER                       | 220                                                    |
| CERTIFICATE NUMBER                             | 286                                                    |
| STATE FILE NUMBER                              | 9230                                                   |
| 1. FULL NAME OF DECEASED                       | INFANT BOY STEPHENS                                    |
| 2. SEX                                         | Male [X] Female [ ]                                    |
| 3. COLOR OR RACE                               | White                                                  |
| 4. DATE OF DEATH                               | April 16, 1961                                         |
| 5. AGE OF DECEASED                             | If Under 1 Year:  | If Under 1 Day: Hours: 10          |
| 6. NAME OF HOSPITAL OR INSTITUTION             | Maryview Hospital                                      |
| 7. CITY OR TOWN                                | Portsmouth                                             |
| 8. COUNTY OF DEATH                             | Norfolk                                                |
| 9. INSIDE CITY OR TOWN LIMITS?                 | Yes [X] No [ ]                                         |
| 10(a) State or Foreign Country                 | Virginia                                               |
| 10(b) RESIDENCE: COUNTY                        | Norfolk                                                |
| 10(c) City or Town                             | Portsmouth                                             |
| 10(d) Address                                  | 218 Elizabeth Road                                     |
| 11. NAME OF FATHER OF DECEASED                 | Ronald D. Stephens                                     |
| 12. MAIDEN NAME OF MOTHER OF DECEASED          | Irene Ashley                                           |
| 13. CITIZEN OF WHAT COUNTRY                    | USA                                                    |
| 14. MARITAL STATUS                             | Married [ ] Widowed [ ] Never Married [X] Divorced [ ] |
| 15. SPOUSE:                                    | blank                                                  |
| 16. USUAL OR LAST OCCUPATION                   | blank                                                  |
| 17. KIND OF BUSINESS OR INDUSTRY               | blank                                                  |
| 18. BIRTHPLACE                                 | Portsmouth, Virginia                                   |
| 19. DATE OF BIRTH                              | April 15, 1961                                         |
| 20. RESIDENCE OF DECEDENT                      | Portsmouth                                             |
| 21. IF DEATH OCCURRED IN HOSPITAL WAS DECEASED | blank                                                  |
| 23. PART I. DEATH WAS CAUSED BY                | Immediate cause: prematurity Due to: unknown           |
| INTERVAL BETWEEN ONSET AND DEATH               | 10 hrs.                                                |
| 24. AUTOPSY?                                   | Yes [ ] No [X]                                         |
| PERSON TO WHOM CERTIFICATE ISSUED              | 776                                                    |
| 26. PLACE OF BURIAL OR REMOVAL OR CREMATION    | Greenlawn Memorial Park                                |
| 27. DATE OF BURIAL OR REMOVAL OR CREMATION     | 4/17/61                                                |
| 28. FUNERAL DIRECTOR                           | Hollomon-Brown Funeral Home, Inc.                      |
| 29. REGISTRAR                                  | Helen C. Polson deputy                                 |
| DATE RECEIVED                                  | 5-1-61                                                 |
| 24a. DATE OF PHYSICIAN SIGNATURE               | 4/16/61                                                |
| 25. CERTIFY I ATTENDED THE DECEASED FROM       | 4/15/61 TO 4/16/61                                     |
| SIGNATURE AND TITLE                            | W. B. Pope Jr. M. D.                                   |
| DATE SIGNED                                    | 4/16/61                                                |
| ADDRESS                                        | Portsmouth VA                                          |
|------------------------------------------------|--------------------------------------------------------|

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