James Matthews HEPNER Death Certificate

City of Brownsville, Texas

The Office of the City Secretary

STATE OF TEXAS

CERTIFICATE OF DEATH

STATE FILE NUMBER: [blank]

1. NAME OF DECEASED: James Matthews Hepner

2. SEX: Male

3. DATE OF DEATH: March 20, 1995

4. DATE OF BIRTH: June 16, 1921

5. AGE: 73

6. BIRTH PLACE: Indianapolis, Indiana

7. SOCIAL SECURITY NO.: 453-28-1594

8. RACE: White

9a. WAS THE DECEDENT OF HISPANIC ORIGIN? No

9b. IF YES...: [blank]

10. WAS DECEDENT EVER IN U.S. ARMED FORCES? No

11. EDUCATION: 12

12. MARITAL STATUS: Divorced

13. SURVIVING SPOUSE: [blank]

14a. DECEDENT'S USUAL OCCUPATION: Mortician

14b. KIND OF BUSINESS OR INDUSTRY: Funeral Service

15a. RESIDENCE STREET ADDRESS: 1001 Central Blvd.

15b. CITY OR TOWN: Brownsville, TEXAS

15c. COUNTY: Cameron

15d. STATE: Texas

15e. ZIP CODE: 78520

15f. INSIDE CITY LIMITS? Yes

16. FATHER'S NAME: Iva Arthur Glee Hepner

17. MOTHER'S MAIDEN NAME: Thelma Jewel Bolin

18. PLACE OF DEATH: Hospital Inpatient

19. COUNTY OF DEATH: Cameron

20. CITY OR TOWN: Brownsville

21. NAME OF HOSPITAL OR INSTITUTION: Brownsville Medical Center

22. INFORMANT-SIGNATURE AND RELATIONSHIP: John C. Hepner, Son

23. MAILING ADDRESS OF INFORMANT: P.O. Box 507, Denton, Tx. 76202-0507

24. METHOD OF DISPOSITION: Burial

25a. PLACE OF DISPOSITION: Buena Vista Memorial Park

25b. SECTION...: unknown

26. LOCATION: Brownsville, Texas

27. SIGNATURE OF FUNERAL DIRECTOR OR PERSON ACTING AS SUCH: Jimmy B. Simerly

5609

28. DATE OF DISPOSITION: 3-22-1995

29. NAME AND ADDRESS OF FUNERAL HOME:

Buck Ashcraft Funeral Home

710 Ed Carey Dr.

Harlingen, Texas 78550

30. CERTIFIER: Certifying Physician

31. SIGNATURE: Gonzalez, M.D.

32. DATE SIGNED: 4-12-95

33. TIME OF DEATH: 10:30 a.m.

34. PRINTED NAME AND ADDRESS OF CERTIFIER: Dr. Victor M. Gonzalez, 1144 Professional Dr., Brownsville, Texas 78520

35. PART 1 ENTER THE DISEASES...

IMMEDIATE CAUSE OF DEATH: (a) Respiratory Failure

Approximate Interval Between Onset and Death: 48 hrs.

DUE TO: (b) Emphysema

Approximate Interval Between Onset and Death: unknown

Part 2 OTHER SIGNIFICANT CONDITIONS...: Hyper CL???? Arteriosclerosis

36a. AUTOPSY? No

36b. AUTOPSY FINDINGS...: [blank]

37. DID TOBACCO USE CONTRIBUTE TO DEATH: Yes

38. DID ALCOHOL USE CONTRIBUTE TO DEATH: No

39. WAS DECEDENT PREGNANT: No

40. MANNER OF DEATH: Natural

41a-f. (injury) [blank]

42a. REGISTRAR FILE NO.: 02-0873-95

42b. DATE RECEIVED BY LOCAL REGISTRAR: 01-31-96

42c. SIGNATURE OF LOCAL REGISTRAR: Melissa Dennany Morales, City Secretary

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