Reg. Dist. No. 494
Primary Reg. Dist. No. 6227 |
OHIO DEPARTMENT OF
HEALTH
COLUMBUS
CERTIFICATE OF DEATH
Department of Commerce -
Bureau of the Census |
State File No. 61068
Registrar's No. 5799 |
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PERSONAL AND STATISTICAL PARTICULARS |
MEDICAL CERTIFICATE OF DEATH |
1. PLACE OF DEATH:
(a) County: Hamilton
(b) City: Cincinnati
(c) Name of hosp or inst: (blank)
(d) Length of stay: in hosp. or insti: (blank)
In this community: 76- (years, months, days) |
2. USUAL RESIDENCE OF DECEASED:
(a) State: Ohio (b) County: Hamilton
(c) City: Cincinnati
(d) Street No. 3174 Harrison Ave.
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3. FULL NAME:
ANNA AUPPERLE HAINES
(a) if veteran, name war: NO
(b) Social Security No.: NONE |
MEDICAL CERTIFICATION
20. Date of death: October 19th, 1946, 11 a.m.
21. I hereby certify that I attended the deceased from
July, 1845 to October, 1846; that I last saw her alive on
October, 1846 and that death occurred on the date and hour
stated above.
Immediate cause oaf death:
Carcinoma of Colon - Duration: 18 months
22. (blank)
23. Signature: Edwin K____ M. D.
Address: 1923 Central____
Date signed: Oct. 23, 1946 |
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4. Sex: Female 5. Color or Race: White
6(a) Widow
6(b) Name of husband: Willard D. Haines
6(c) Age of husband if alive: (blank)
7. Birth date of deceased: Dec. 25, 1869 |
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8: AGE: 76 yrs. 9 mos. 24 days |
9. Birthplace: Cincinnati, Ohio
10. Usual occupation: At Home
11. Indust. or business: (blank)
12. Name of Father: Alexander Aupperle
13. Birthplace of Father: Cincinnati, Ohio
14. Maiden name of mother: Julia Deible
15. Birthplace: Unknown
16(a) Informant's signature: Grace Haines
16(b) Address: 3174 Harrison Ave. Cint.
17(a) Burial, cremation, or other:
(b) Date: 10-22-1946
(c) Place: Rest Haven Cemetery
(d) Name of Embalmer: Wain A. Bolton
Lic. No. 3882R
18(a) Signature of Funeral Director: Wain A. Bolton
Lic. No. 2210
(b) Address: 3042 Harrison Ave.
19(a) Date rec. loc. registrar: Oct. 26, 1946
(b) Registrar's sig: Grace LePoris, DEPUTY |
