OHIO DEPARTMENT OF HEALTH
DIVISION OF VITAL STATISTICS
CERTIFICATE OF DEATH
|
PLACE OF DEATH Holmes Co. |
CITY OR VILLAGE Millersburg |
HOSPITAL OR INSTITUTION Castle Nursing Home |
INSIDE CITY LIMITS? Yes |
|
USUAL RESIDENCE Washington Co. OH |
CITY OR VILLAGE Lowell |
INSIDE CITY LIMITS? Yes |
RESIDENCE ON A FARM? Yes |
|
NAME Fanny Augustein |
DATE OF DEATH March 11, 1965 |
SEX Female |
COLOR OR RACE White |
MARITAL STATUS Widowed |
DATE OF BIRTH 8/13/1880 |
AGE 84 |
|
OCCUPATION Housewife |
BUSINESS OR INDUSTRY Own Home |
BIRTHPLACE Ohio |
CITIZEN OF WHAT COUNTRY USA |
FATHER John Dobbins |
MOTHER Sarah Stevens |
INFORMANT Effie Stevens, Beverly OH |
|
IMMEDIATE CAUSE OF DEATH Coronary thrombosis |
INTERVAL BETWEEN ONSET & DEATH 15 min. |
|
CONDITIONS WHICH GAVE RISE TO ABOVE CAUSE Cardio vascular renal disease |
INTERVAL BETWEEN ONSET & DEATH 3 years |
|
SIGNIFICANT CONTRIBUTING CONDITIONS Influenza |
AUTOPSY PERFORMED No |
|
ATTENDED FROM Jan. 1965 TO Mar. 11, 1965 |
LAST SAW ALIVE 3/10/65 |
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SIGNATURE M.P. Stauffer, MD |
ADDRESS Millersburg, Ohio |
|
BURIAL Mar. 14, 1965 |
CEMETERY Greenlawn |
|
CEMETERY LOCATION Lowell, Ohio |
FUNERAL FIRM Peoples Funeral Home |