Death Certificate

		STATE OF OHIO DEPARTMENT OF HEALTH DIVISION OF VITAL STATISTICS CERTIFICATE OF DEATH
1 PLACE OF DEATH County MONTGOMERY Township Jefferson or Village or City of Dayton, O.		Registration District No. 904 Primary Registration District No. 5374 No -, - St., - Ward		File No. 1445 Registered No.
2 FULL NAME Charles U. Shank			Did Deceased Serve in U. S. Navy or Army
(a) Residence. No., R. R. #6			Ward
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			MEDICAL CERTIFICATE OF DEATH
3 SEX Male	4 COLOR OR RACE White	5 Single, Married, Widowed or Divorced Married	16 DATE OF DEATH 7-11 1925
5a If married, widowed, or divorced HUSBAND of (or) WIFE of			17 I HEREBY CERTIFY, That I attended deceased from 6-28 1925 to 7-11 1925, that I last saw him alive on 7-11 1925, and that death occurred, on the date stated above, at 11 am.
6 DATE OF BIRTH 3-17-1885
7 AGE Years Months Days 40 3 24		If LESS than 1 day, - hrs, or - min.	The CAUSE OF DEATH was as follows: Typhoid Fever (duration) - yrs, - mos, 14 ds.
8 OCCUPATION OF DECEASED (a) Trade, profession, or particular kind of work Farmer (b) General nature of Industry, business, or establishment in which employed (or employer) (c) Name of employer			Contributory Hemorrhage (intestinal) (duration) - yrs, - mos, 11 ds.
9 BIRTHPLACE Ohio			18 Where was the disease contracted if not at place of death? Did an operation precede death? - Date of - Was there an autopsy? What test confirmed diagnosis?
PARENTS	10 NAME OF FATHER Emanuel Shank
	11 BIRTHPLACE OF FATHER Ohio
	12 MAIDEN NAME OF MOTHER Alice Caylor
	13 BIRTHPLACE OF MOTHER Ohio		(Signed) R. R. Shank, M. D. 7-12, 1925 (Address) Trotwood, O.
14 Informant Chas. Neff (Address) Trotwood, Ohio			19 PLACE OF BURIAL, CREMATION, OR REMOVAL Lower Miami	DATE OF BURIAL 7-13 1925
15 Filed JUL 13 1925		R. C. Pennywitt Registrar	20 UNDERTAKER, License No. Abram Conover	Address New Lebanon O.

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last modified: 98.07.13