Source
Transcription
County Decatur Indiana State Board of Health Registered Number 35435
Bureau of Vital Statistics
Town Greensburg
No. I.O.O.F. Home St.
Full Name Fredrick D. White
Personal and Statistical Particulars
| Sex | Color or Race | Single, Married, Widowed or Divorced |
|---|---|---|
| Male | White | Married |
HUSBAND of (or) WIFE of Sarah Jane Couch
DATE OF BIRTH (month, day and year) SEPT 26, 1851
AGE 87 Years 2 Months 27 Days
Trade, profession or particular kind of work RETIRED
Birth place NEW YORK
FATHER
Name Artemas White
Birthplace Vermont
MOTHER
Maiden name Lyda Brumley
Birthplace New York
Informant Wilbert Grayson
Greensburg, Ind.
Place of burial or removal South Park - Greensburg Date ?? 19 1938
Undertaker Chrs. R. Howe, Greensburg, Ind.
Was the body embalmed? Yes Embalmers License No. 3622
Filed 12.17.1938 G.M. Sanders
Medical Certificate of Death
Date of Death Dec. 19 1938
I hereby certify that I attended deceased from Apr 15 1938 to Dec 17 1938 and that death occurred on the above date at 4 A.M.
The principal cause of death and related causes of importance were as follows:
Prostatic Hypertrophy
Other contributory causes of importance:
Chronic? Nephritis
Signed by N.C. Allington?, M.D.
? 17 1938 Greensburg Ind
Notes
refersto::Frederick D. White refersto::Sarah Jane Couch
“IOOF Home” is probably “Independent Order of Odd Fellows Home” in Greensburg, Indiana