William Riley Dwight HEPNER Death Certificate

Indiana State Board of Health

CERTIFICATE OF DEATH

Registered No.: 216 (15860 stamped)

1. PLACE OF DEATH:

County of: Lake

Township of: North

Town of: [blank]

or

City of: Hammond

(No. 367, Truman Blvd St., [blank] Ward)

2. FULL NAME: Dewight Hepner

PERSONAL AND STATISTICAL PARTICULARS

3. SEX: Male

4. Color or Race: White

5. Single...: Married

6. DATE OF BIRTH: June 28, 1866

7. AGE: 58 years, 10 months, 26 days

8. OCCUPATION:

a. Trade...: Weigh Master

b. General nature of Industry...: Mark Plant

9. BIRTHPLACE of DECEASED: Indiana

PARENTS:

10. NAME OF FATHER: Mathis Hepner

11. BIRTHPLACE OF FATHER: Ohio

12. MAIDEN NAME OF MOTHER: Lavica Spoor

13. BIRTHPLACE OF MOTHER: Indiana

14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

(Informant) Norton Hepner

(Address) Hammond, Ind.

15. Filed 5 24, 1924

Name and Address of Health Officer or Deputy: Wm. A. Buchanan

MEDICAL CERTIFICATE OF DEATH

16. DATE OF DEATH: May 24, 1924

17. I HEREBY CERTIFY, That I attended deceased from May 15, 1924 to to May 24, 1924, that I last saw Him alive on May 24 at 1 am, 1924 and that death occurred, on the date stated above, at 1:15 A.M.

The CAUSE OF DEATH was as follows:

Angina Pectoris

Intermittent Attacks for 3 ds.

Contributory: Acute Articular Rheumatism

Duration: 10 ds.

(Signed) C. W. Campbell, M.D.

May 24, 1924

(Address) Hammond

18. LENGTH OF RESIDENCE... [blank]

19. PLACE OF BURIAL OR REMOVAL: Oak Hill Cem., Knox, Indiana

DATE OF BURIAL: 5/26/24

20: UNDERTAKER: CHas. H. Stewart

21. ADDRESS: Hammond

WAS THE BODY EMBALMED? Yes

EMBALMER'S LICENSE NO.: 259