Harry Glee HEPNER Death Certificate

STANDARD CERTIFICATE OF DEATH
INDIANA STATE BOARD OF HEALTH
BUREAU OF VITAL STATISTICS

Local No. 656
Registered No. 27112

PLACE OF DEATH
County: St. Joseph
Incorporated: Portage
Town or City: So. Bend

FULL NAME: Harry Gee Hepner
Residence: 316 So. Franklin

PERSONAL AND STATISTICAL PARTICULARS
SEX: M
COLOR OR RACE: W
Single, Married, Widowed or Divorced: Married
HUSBAND OR WIFE: Kathryn Hepner
DATE OF BIRTH: Sept. 25, 1874
AGE: 63 years

OCCUPATION:
Trade: ["Taylor" crossed out]
Industry: Tailor
Date deceased last worked at his ocupation: [blank]
Total time (years) spent: 50

BIRTHPLACE: Knox, Ind.

FATHER
NAME: Matt T. Hepner
BIRTHPLACE: Champane, Ohio

MOTHER
MAIDEN NAME: L. Bliss Spoor
BIRTHPLACE: Ind.

MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH: Aug. 22, 1937
I HEREBY CERTIFY, That I attended deceased from Aug. 17, 1937 to Aug. 22, 1937 and that death occurred, on the date stated above, at 6 A.M. The principal cause of death and related causes of importance were as follows:
Uremia (Nephritis)
Date of onset: Aug. 10, '37
Other contributary causes of importance:
Prostatitis
Date of onset: Aug. 10, '37
Name of operation: None
Date of: [blank]
What test confirmed diagnosis?: Clinical
Was there an autopsy?: [blank]
If death was due to external causes (violence) fill in also the following:
Accident, suicide, or homicide?: No
[remainder of section is blank]
Was disease or injury in any way related to occupation of deceased?: No

Signed: K. E. Selby, M.D.
8/23/37

INFORMANT: Mrs. H. G. Hepner
316 So. Franklin

PLACE OF BURIAL OR REMOVAL: Highland
Date: Aug. 24, 1937
UNDERTAKER: L. H. Orvis
ADDRESS: So. Bend
WAS THE BODY EMBALMED?: Yes
EMBALMER'S LICENSE No. 482

Filed [date blank]
Health Officer or Deputy: Dr. Minola Carter