Lovisa Bliss SPOOR (Hepner) Death Certificate

Indiana State Board of Health

CERTIFICATE OF DEATH

PLACE OF DEATH:

County of: Starke

Township of: Center

Town of: Knox

Or

City of: Ind (No. [blank], [blank] St.; [blank] Ward)

Registered No.: 3246

FULL NAME: Lovisa Bliss Hepner

PERSONAL AND STATISTICAL PARTICULARS

SEX: Female

COLOR OR RACE: White

SINGLE . . .: Married

NAME OF HUSBAND OR WIFE: M. T. Hepner

DATE OF BIRTH: Feb 9, 1840

AGE: 78 years, 11 months, 22 days

OCCUPATION:

a. Trade . . .: House Wife

b. General Nature of Industry: [blank]

BIRTHPLACE: Miami Co Ind

NAME OF FATHER: Thos D Spoor

BIRTHPLACE OF FATHER: Vermont

MAIDEN NAME OF MOTHER: Sarah Wait

BIRTHPLACE OF MOTHER: Ohio

THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

Informant: Oliver Hepner

Address: Knox Ind

MEDICAL CERTIFICATE OF DEATH

DATE OF DEATH: Jan 31 1919

I HEREBY CERTIFY, that I attended deceased from Aug 1 1918 to Jany 31 1919, that I last saw her alive on January 31 1919, and that death occurred, on the date stated above, at 830 [overlapping letters cannot be read] ?M.

The CAUSE OF DEATH was as follows:

General Paralysis

Duration: [blank] years, 6 months, 0 days

Contributory: [blank]

(Signed) M. P. Shares [?], M.D.

2/1, 1919

(Address) Knox, Ind

LENGTH OF RESIDENCE: [blank]

FILED: Feb 1, 1919

Name and Address of Health Officer or Deputy: Geo W Sarbes, Knox Ind

PLACE OF BURIAL OR REMOVAL: Oak Park Cemetery

DATE OF BURIAL: Feb 3, 1919

UNDERTAKER: Thos. C. Hite

ADDRESS: Knox Ind

WAS THE BODY EMBALMED? Yes

EMBALMER'S LICENSE NO.: 1101