| Text |
State Department of Health - Bureau of Vital Statistics
CERTIFICATE AND RECORD OF DEATH
Registered No. 2113
Personal and Statistical Particulars
1 Place of Death - Hudson County, Jersey City, No St Francis Hosp
2 FULL NAME - John Dauenhauer.
3 Residence = 54 Stevens Ave., jersey City, N.J.
4 Sex - Male, 5 Color or Race - White, 6 Single.
7 If married, widowed or divorced HUSBAND of (or) WIFE of - .
8 Date of Birth - May 10th 1870.
9 Age - 54 yrs, 6 mos, ds.
10 Occupation - Butcher.
11 Birthplace - New York City, New York.
PARENTS
12 Name of Father - Frederick Dauenhauer.
13 Birthplace of Father - Germany.
14 Maiden name of Mother - Mary Doll
13 (a) Birthplace of Mother - Germany.
15 Signature of Informant Julia Dauenhauer, (Address) 54 Stevens Ave. Jersey City.
16 Filed - xxx xx, 1924
Medical Certificate of Death
17 Date of Death - Dec 12, 1924
18 I HEREBY CERTIFY That I attended deceased from Dec 8, 1924 to Dec 12 1924
that I last saw him alive on Feb 15, 1920 and that death occurred on the date above
stated, at 9.xx a.m..
The CAUSE OF DEATH was as follows: Duodenal Ulcer, (duration) ds.
Contributory (Secondary) - (Duration) yrs.
19 Where was disease contracted if not at place if death - Home.
Did an operation precede death - No, Date of - .
Was there an autopsy - No.
What test confirmed diagnosis - Physical & Clinical
Signed Wm A Lxxxxx (Address) St Francis Hosp.
20 Place of Burial or Removal - Holy Name Cem J.C., Date of Burial - December 17, 1924
21 Undertaker - Richard D Routh, Address - 202 Old Bergen Road, New Jersey License No - 659 |
