Matthias T. HEPNER Death Certificate

Indiana Sate Board of Health

CERTIFICATE OF DEATH

PLACE OF DEATH:

County of: Starke

Township of: Center

Town of: Knox

City of: [blank] (No. [blank], [blank] St., [blank] Ward)

Registered No.: 36844

FULL NAME: Matthias T. Hepner

PERSONAL AND STATISTICAL PARTICULARS

SEX: Male

Color or Race: White

Single . . .: Widowed

NAME OF HUSBAND OR WIFE: [blank]

DATE OF BIRTH: April 9, 1834

AGE: 93 years, 8 months, 19 days

OCCUPATION: [blank]

BIRTHPLACE OF DECEASED: Champaign Co. Ohio

PARENTS:

NAME OF FATHER: Matthias Hepner

BIRTHPLACE OF FATHER: Salem Co. N.J.

MAIDEN NAME OF MOTHER: Mary Turnpaugh

BIRTHPLACE OF MOTHER: Indiana

THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

Informant: Oliver Hepner

(Address): Knox Ind

MEDICAL CERTIFICATE OF DEATH

DATE OF DEATH: Dec 28, 1927

I HEREBY CERTIFY, That I attended deceased from Dec [day too faint to read], 1927, to Dec. 28, 1927, that I last saw him alive on Dec [day too faint to read], 1927, and that death occurred, on the day stated above, at 11 A.M.

The CAUSE OF DEATH was as follows:

Obstruction of heart

Duration: [blank]

CONTRIBUTORY: Influenza

Duration: [blank]

Signed: [signature too faint to read], M.D.

[date too faint to read] ADDRESS: [too faint to read clearly] Knox (?)

LENGTH OF RESIDENCE: [blank]

Filed: Dec. 29, 1927

Name and Address of Health Officer or Deputy: Geo. W. Sarbes, Knox, Ind.

PLACE OF BURIAL OR REMOVAL: Knox Oak Park

DATE OF BURIAL: Jan 2, 1928

UNDERTAKER: Thos. C. Hite

ADDRESS: Knox Ind

WAS THE BODY EMBALMED? Yes

EMBALMER'S LICENSE NO.: 1101