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DEATH CERTIFICATES

 

STATE OF OHIO
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH

PLACE OF DEATH: Hamilton
Regis. No. 494 - File No. 39739 - Primary Dist. NO. 8227 - Reg. No. 3539
City of Cincinnati  No. 4232 Williamson Pl.
FULL NAME:   Raymond Cole

PERSONAL & STATISTICAL PARTICULARS
3. Sex: Male  4. Color or Race: White
DATE OF BIRTH:  June 10, 1917
AGE:  Still B
OCCUPATION:  None
BIRTHPLACE: Cinti, O.
PARENTS:
Father: Raymond Cole
Birthplace of Father: Cincti, O.
Mother: Agnes Zepf
Birthplace of Mother: Cincti, O.
 
The above is true to the best of my knownledge:
Informant: Raymond Cole
Address 4232 Williamson Pl.




Filed: Jun. 11, 1917 - Ewalter Evans, Registrar
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH: June 10, 1917
17.  I Hereby Certify, That I attended deceased from June 10, 1917 to June 10, 1917.  I last saw him alive on ___(blank)____, death is said to have occurred on the date stated above at 8 p.m.
The CAUSE OF DEATH was as follows:
Premature Birth
Stillborn
CONTRIBUTORY over exertion by mother
Signed Mary Roush Kreiger, M. D.
June 10, 1917 -Address: 854 W. 7th. St.
18.  LENTH OF RESIDENCE:  N/A
19. PLACE OF BURIAL OR REMOVAL
St. Joseph's Old. 
DATE OF BURIAL:  Jun. __ 1917?
Signed Henry F. K___
Date 3/4/1931  Address 1674 Chase, Cinci, O
20. UNDERTAKER:  ___? Borgeraund?
ADDRESS:  Cincti, O.
(Contributed by Lori Chaffin from family records)

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