DEPARTMENT OF COMMERCE
BUREAU OF THE CENSUS |
STATE OF OHIO
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH |
Social Security No.
___ |
1. PLACE OF DEATH:
County of Hamilton
Registration District No. 211
File No. 21593
__________ Registration District No. 2207
Registered No. 16
Village Blanchester
2. FULL NAME:
Carrie M. Riley
(a) Residence No. Blanchester,
Ohio
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PERSONAL AND STATISTICAL PARTICULARS |
MEDICAL CERTIFICATE OF DEATH |
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3. SEX: F |
4. COLOR OR RACE:
W |
5. Single, Married, Widowed or Divorced:
Widowed |
21. DATE OF DEATH: April 8, 1942 |
22. I HEREBY CERTIFY, That I attended
deceased from April 8, 1942 to April 8, 1942.
I last saw her alive on April 8, 1942 and that death is
said to have occurred, on the date stated above at 9:30
p.m.?
The PRINCIPAL CAUSE OF DEATH and related causes of
importance in order of onset were as follows:
Coronary Thrombosis |
5a. If married, widowed or divorced.
WIFE of Lewis M. Riley |
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DATE OF BIRTH: Feb. 23?, 1855 |
7. AGE:
87 Years |
Months:
1 |
Days:
15 |
8. OCCUPATION OF DECEASED:
At Home
9. (blank)
10. (blank)
11. (blank) |
CONTRIBUTORY CAUSE of importance not
related to principal cause:
Senility
23. If death was due to external causes (violence) fill in
also the following:
(blank) |
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12. BIRTHPLACE: Cincinnati, O |
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13. NAME OF FATHER: Alexander
Aupperle |
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14. BIRTHPLACE OF FATHER: Cincinnati, Ohio |
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15. MAIDEN NAME OF MOTHER: Julia A. Dieble |
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16. BIRTHPLACE OF MOTHER: At Sea |
17. INFORMANT Signature: Julia Williams
Address: Blanchester |
24. Was disease or injury in any way
related to occupation of deceased? (blank) |
18. Burial, Cremation or Removal:
Blanchester, O Date: April 11, 1942 |
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19. FUNERAL FIRM: C. B.
Eschelonger?
19a. BURIED BY: Same Lic. No. 39
19b. EMBALMER: J. __ Keefe? Lic. No. 4266A |
(Signed) A. B. Martin, M. D.
Date (blank)
Address: Blanchester, O. |
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20. FILED: 5/5/1942 (illegible),
Registrar |
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