Transcription – Death Certificate of Rebecca Ann Ott

Transcription – Death Certificate of Rebecca Ann Ott

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The following is my transcription of the death certificate of Rebecca Ann Ott, wife to Samuel G. Ott, of Canal Fulton, Ohio.

DEATH CERTIFICATE OF Rebecca Ann Ott

Death Certificate of Rebecca Ann Ott
Death Certificate of Rebecca Ann Ott

STATE OF OHIO
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH

1    PLACE OF DEATH
County   Portage    Registration District No.   1058        File No.
Township                                     Primary Registration District No.   8415    Registered No.   44255
or Village           No.     ,                                      St.,                                                  Ward
or City of   Kent, Ohio    (If death occurred in a hospital or institution, give its NAME  instead of street and number)

2    FULL NAME   Rebecca Ann  Ott
(a)    Residence.    No.              St.,                                            Ward
(Usual place of abode)                    (If nonresident, give city or town and State)
Length of residence in city or town where death occurred                 yrs.             mos.             ds.    How long in  U.S., if of foreign birth?                 yrs.              mos.            ds.

PERSONAL AND STATISTICAL PARTICULARS

3    SEX                               4    COLOR OR RACE                          5    SINGLE, MARRIED, WIDOWED or DIVORCED (write the word)                          5a    If married, widowed or divorced
Female                                 White                                                      Married                                                                                                                                           HUSBAND of    Samuel G. Ott
(or) WIFE of

6    DATE OF BIRTH (month, day, and yer)    Jan. 2nd, 1846
7    AGE                Years                Months                 Days        If LESS than 1 day               hrs. or                 min.
8    OCCUPATION OF DECEASED
(a)    Trade, profession or particular kind of work         Housewife
(b)    General nature of Industry, business, or establishment in which employed (or employer)
(c)    Name of employer
9    BIRTHPLACE (city or town)        Canal Fulton        State or country    O
PARENTS
10    NAME OF FATHER    Joseph Kirk
11    BIRTHPLACE OF FATHER (city or town)                    (State or country)    Unknown
12    MAIDEN NAME OF MOTHER            Unknown
13    BIRTHPLACE OF MOTHER (city or town)        Canal Fulton        (State or country)    Ohio
14    Informant    Samuel G. Ott
(Address)    Canal Fulton, O
15    Filed     8/19, 1922        Frank Bechiter   Registrar

MEDICAL CERTIFICATE OF DEATH

16    DATE OF DEATH (month, day and year)    Aug. 16,  1922
17                                      I HEREBY CERTIFY, that I attended deceased from             , 1917, to Aug. 16th, 1922
that I last saw her alive on July 15th, 1922 and that death occurred, on the date stated above, at 8oo P.m.
The CAUSE OF DEATH* was as follows:    Myxedima     (duration)           yrs.            mos.         ds.
CONTRIBUTORY (secondary)         Unknown        (duration)                     yrs.            mos.         ds.
18    Where was the disease contracted if not at the place of death?
Did an operation precede death?     No        Date of
Was there an autopsy?        No
What test confirmed diagnosis?        Physical exam
(Signed)     Hiram Bessinger, M.D.
Aug. 17th, 1922    (Address)    Canal Fulton, O
State the Disease Causing Death, or in deaths from Violent Causes, state (1) Means and Nature of Injury, and (2) whether Accidental, Suicidal or Homicidal. (See reverse side for additional space.)
19    PLACE OF BURIAL, CREMATION OR REMOVAL            DATE OF BURIAL
Union Cemetery, Canal Fulton, O                                            Aug. 19, 1922
20    UNDERTAKER, License No.                            ADDRESS
The Finefrock Bros. Co.                                     Canal Fulton, O.

____________________

The image above links directly to the original document. You can access sources, data, images and documents for these and other individuals, by clicking on the name link, or searching the Blythe Genealogy database site using the surname search link and the ‘All Media‘ search link in the left sidebar.

It is recommended to search using both methods as the results can differ greatly due to a glitch in the software that doesn’t connect all images from the bio.

All data for this and numerous others on this site is available for free access and download.

 


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