Ivo Arthur Glee HEPNER Death Certificate

Indiana State Board of Health

Certificate of Death

Place of Death:

County of Porter

Township of Center

Village of [blank]

or

City of Valparaiso (No. Christian Hospital, [blank] St.; 1st Ward]

Registered No. 2 [2485 stenciled above this]

FULL NAME: Arthur Glee Hepner

PERSONAL AND STATISTICAL PARTICULARS

SEX: Male

COLOR: White

SINGLE...: Single

NAME OF HUSBAND OR WIFE: [blank]

DATE OF BIRTH: October 30th, 1899

AGE: 24 years, 2 months, 10 days

OCCUPATION:

(a) Fireman

(b) Locomotive

BIRTHPLACE: Knox Indiana

NAME OF FATHER: Harry Hefner

BIRTHPLACE OF FATHER: Knox Indiana

MAIDEN NAME OF MOTHER: Lila Slidinger

BIRTHPLACE OF MOTHER: Cicero Ind.

The above is true to the best of my knowledge:

(Informant) Mrs. Thos. Maughan

(Address) 9128 Harper Ave

Chicago

Filed 1-10-1924

C. H. DeWitt, M.D. (Name and Address of Health Officer or Deputy)

CORONER CERTIFICATE OF DEATH:

DATE OF DEATH: Jan 9th, 1924

I HEREBY CERTIFY, That I took charge of the remains described above, held an Inquest thereon and from the evidence obtained by said Inquest find that said deceased came to his death on the day stated above, at 9:30 P.M. The CAUSE OF DEATH was as follows:

Accidental death

Skull fracture

(Duration) [blank] yrs. [blank] mos. 3 hours ds.

Contributory: Railroad Locomotive wreck

(Duration) 5 yrs. [blank] mos. [blank] ds.

(Signed) Herman O. Seipel, M.D. [Coroner...]

Jan 10, 1924 (Address) Valparaiso

LENGTH OF RESIDENCE

Former or Usual Residence: Chicago, Ills

PLACE OF BURIAL OR REMOVAL: Chicago Ill

DATE OF BURIAL: Jan 14, 1924

WAS THE BODY EMBALMED? Yes

UNDERTAKER: Chas H Stenchfield

ADDRESS: Valparaiso

NO. OF LICENSE: 1855