|
PERSONAL AND STATISTICAL PARTICULARS |
3. SEX:
Female |
4. COLOR OR RACE:
White |
5. Single, Married,
Widowed or Divorced:
Married |
|
5a. If
married, widowed or divorced
WIFE of: Casimer Zepf |
| 6. DATE OF
BIRTH: June 2, 1859 |
| 7. AGE: 73
yrs 8 mos. 14 days |
OCCUPATION:
8. Housewife
9. (blank)
10. (blank) 11. (blank) |
| 12.
BIRTHPLACE: Germany |
| 13.
FATHER'S NAME: Stephen Grable (Graule?) |
| 14.
FATHER'S BIRTHPLACE: Germany |
| 15.
MOTHER'S MAIDEN NAME: Teresa Schlecht |
| 16.
MOTHER'S BIRTHPLACE: Germany |
17. The
signature of INFORMANT: Stephen Zepf
Address: 4215 Williamson Pl. |
| 18.
BURIAL, CREMATION OR REMOVAL: St.
Joseph Old Date: Feb. 20, 1933 |
19.
UNDERTAKER: Chas. A. Miller Sons
(Address) Cinti
19a. Was body embalmed Yes
Embalmer's No. 2382A |
20. FILED:
Feb. 20, 1933
E. Waller E____, Registrar |
|
|
MEDICAL CERTIFICATE OF DEATH: |
|
21 DATE OF DEATH: Feby 16,
1933 |
22. I HEREBY CERTIFY, That
I attended deceased from Nov. 17, 1932, to
Feb. 16, 1933, I last saw her alive on
Feb. 15, 1933, death is said to have
occurred on the date stated above at 6:10
a.m.
The PRINCIPAL CAUSE OF DEATH and related
causes of importance in order of onset
were as follows:
Vascular heart disease - Date of onset:
Nov. 17
CONTRIBUTORY CAUSES of importance not
related to principal cause:
Arteriosclerosis - Date of Onset: Nov. 17 |
23. (blank)
|
24. (Signed) J. S. Tarrant,
M. D.
Date: Feb. 18, 1933
Address: 1553 Chase Ave. |
|
