|
PERSONAL AND
STATISTICAL PARTICULARS |
| 3.
SEX: M |
4.
COLOR OR RACE: W |
5.
Single, Married, Widowed or Divorced: Single |
|
| 5a. If Married,
widowed or divorced.... (blank) |
| 6. DATE OF BIRTH:
Aug. 1, 1913 |
| 7. AGE: 20
years |
____ Months |
22 Days |
|
| 8. Trade,
profession or particular kind of work done: U. S.
Army |
| 9. Industry or
business in which work was done: Soldier |
| 10: Date deceased
last worked at this occupation: (blank) 11.
Total time: (blank) |
| 12. BIRTHPLACE:
Loveland, Ohio |
PARENTS:
13. FATHER'S NAME: George Keating |
| 14. FATHER'S
BIRTHPLACE: Ohio |
| 15. MOTHER'S
MAIDEN NAME: Alice Kneipp |
| 16. MOTHER'S
BIRTHPLACE: Cincinnati, Ohio |
17. Signature of
INFORMANT: Alice Brunck
and (Address) 5201 Ravenna st. |
18. BURIAL,
CREMATION OR REMOVAL:
Place: Laurel Cem. Date Aug. 28, 1933 |
19. UNDERTAKER:
Thomas Funeral Home
(Address) Cin, Ohio
19a. Was body embalmed: Yes
Embalmer's No. 4208A |
20. FILED: Aug.
25, 1933
E. Waller? E__, Registrar |
|
|
MEDICAL
CERTIFICATE OF DEATH: |
| 21. DATE OF DEATH:
August 24, 1933 |
22. I HEREBY
CERTIFY, That I attended deceased from August 21,
1933, to August 24, 1933, I last saw him alive on
August 24, 1933, death is said to have occurred on
the date stated above at 3:15 a.m.
The PRINCIPAL CAUSE OF DEATH and related causes of
importance in order were as follows:
Generalized Septisemia
CONTRIBUTORY CAUSES of importance not related to
principal cause:
Abssess - Right lower lip - Cause unknown
Name of operation: Blood transfusion
Date of Aug. 21, 1933
What test confirmed diagnosis? Blood culture.
Was there an autopsy? Yes |
23, If death was due to external
causes (violence) fill in also the following:
Accident, suicide, or homicide? No
|
24. Was disease or
injury in any way related to occupation of
deceased: No.
(Signed) B. E. Boyer, M.D.
Date: 8/24/1933 Address 1013 Care? Tower |
|
