1. PLACE OF DEATH:
(a) County: Hamilton
(b) Township: Anderson Twp.
(c) Name of hospital or institution: at Home
(d) Length of stay:_____
In this community: 7 months |
| 3. FULL NAME: Dora K.
Dres |
| 4. Sex: F |
5. Color or race: W |
6(a) Single,
widowed, married divorced: W |
6.(b) Name of husband or wife:
Michael Dres
7. Birthdate of deceased: March 26, 1873 |
| 8. AGE: 74 yrs. |
4 Months |
8 Days |
|
9. Birthplace:
Hamilton Co., Ohio
10. Usual occupation: (blank)
11. Industry or business: at home
12. Name of Father: Peter Kneipp
13. Birthplace of Father: Germany
14. Maiden name: Caroline King
15. Birthplace: Germany
16. (a) Informant's signature: Theodore Dres
(b) Address R#1 Newtown, Ohio
17. (a) Burial cremation or other; (b) Aug. 7, 1947
(c) Place: Calvary Cemetery
(d) Name of embalmer: George W. Monroe (Lic. No.) 3026A
18. (a) Signature of Funeral Director: George W.
Monroe (Lic. No.) 1281
(b) Address: Milford, Ohio
19. Date received local registrar: Aug. 11, 1947
(b) Registrar's signature: Grace LeBris. DEPUTY |
|
2. USUAL RESIDENCE
OF DECEASED:
(a) State: Ohio (b) County: Hamilton
(c) City or Village: Newtown RFD
(d) Street No: Round Bottom Rd. & Y. M. C. A. Rd., Anderson Twp. |
MEDICAL
CERTIFICATION:
20. Date of Death: Month
8 day 4 year 47 hour 5 minute 45
21. I hereby certify that I attended the deceased
from 8-4-1947 to 8-4-1947 that I last saw her
alive on 8-4-1947; and that death occurred on the
date and hour stated above.
Immediate cause of death: Cerebral Hemorrhage -
Duration 8 hrs.
Due to Hypertension
Other conditions: Senility
|
22. (blank)
|
23. Signature: M.
M. Adams, M.D.
Address: Newtown, Ohio Date signed: 8-6-47 |
|
|
