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STATE OF OHIO
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
County of Hamilton
Registration District No. 2532
File No. 21892
Village of Silverton
FULL NAME: Josephine Bloomer |
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PERSONAL AND STATISTICAL PARTICULARS |
MEDICAL CERTIFICATE OF DEATH |
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SEX: Female |
4. COLOR OR RACE: White |
DATE OF DEATH: April 30, 1911 |
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DATE OF BIRTH: Nov. 16, 1909 |
I HEREBY CERTIFY, That I attended deceased
from Apr. 23, 1911 to Apr. 30, 1911 and that death
occurred, on the date stated above, at 1:30 p.m. The
CAUSE OF DEATH was as follows:
Entero Colitis
(Signed) A. O. Sprague M. D.
Silverton, O. |
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DATE OF BIRTH: 1863 - 15th Nov? |
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AGE: 1 years 5 months 14 days |
SINGLE, MARRIED, WIDOWED OR DIVORCED:
Single |
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BIRTHPLACE: Blue Ash, Ohio |
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OCCUPATION: None |
PLACE OF BURIAL or REMOVAL:
Reading, Catholic |
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NAME OF FATHER: John Bloomer |
DATE OF BURIAL: May 2, 1911 |
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BIRTHPLACE OF FATHER: Ohio |
UNDERTAKER: H. Ihlendorf Co.
ADDRESS: Reading, O. |
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MAIDEN NAME OF MOTHER: Mary Kneipp |
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BIRTHPLACE OF MOTHER: Ohio |
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THE ABOVE STATED PERSONAL PARTICULARS ARE
TRUE TO THE BEST OF MY KNOWNEDGE AND BELIEF:
(Informant) John Bloomer
(Address) Silverton, O. |
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