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STATE OF OHIO
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
PLACE OF DEATH: Little Sisters of the Poor
Township of Clifton Heights - Registration Dist. No. 494
File No. 24794
Village ___ Primary Registration District NO. 8227
Registered No. 2671
City of Cin, O. No. Little Sisters Poor R_
FULL NAME: Peter Kneipp |
3. Sex:
Male |
4. Color
or Race
White |
5. Single, Married, Widowed or Divorced:
Widowed |
| 5a. If married, widowed
or divorced: --- |
| 6. DATE OF
BIRTH: Do Not Know |
| 7. AGE: 82
yrs. |
| 8.
OCCUPATION OF DECEASED: Farmer |
| 9.
BIRTHPLACE: Do Not Know |
PARENTS:
10. NAME OF FATHER: Jacob Kneipp |
| 11.
BIRTHPLACE OF FATHER: Do Not Know |
| 12. MAIDEN
NAME OF MOTHER: Do Not Know |
| 13.
BIRTHPLACE OF MOTHER: Do Not Know |
THE ABOVE
IS TRUE TO THE BEST OF MY KNOWLEDGE:
H. Ignatius
Address: Little Sisters of the Poor |
| 15. Apr.
19, 1918 - Ewaller E_____ |
|
| 16. DATE OF DEATH:
April 17, 1918__ |
I HEREBY CERTIFY, That I attended deceased from April 1st
1918 to April 19th, 1918 that I last saw him alive on
April 16, 1918.
The CAUSE OF DEATH was as follows:
Arterio Sclerosis
CONTRIBUTORY: (illegible) |
| (Signed)
(illegible) |
| LENGTH OF RESIDENCE at Place of Death: 3 yrs. 7 mos. |
PLACE OF BURIAL : Catholic Cem - Madisonville
DATE OF BURIAL: April 20, 1918 |
20. UNDERTAKER,
J. J. Sullivan & Co.
ADDRESS: Cinti, O. |
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