| THE COMMONWEALTH OF MASSACHUSETTS STANDARD CERTIFICATE OF DEATH # 726 | |
| NAME OF DECEASED: | Jean Scharin (Hippach) |
| PLACE OF DEATH: | 796 Seaview Ave. Barnstable, Massachusetts |
| USUAL RESIDENCE: | 796 Seaview Avenue Barnstable, Massachusetts |
| SEX: | Female |
| COLOR: | White |
| MARITAL STATUS: | Divorced |
| NAME OF HUSBAND: | "Cannot be Learned" |
| USUAL OCCUPATION: | Housewife |
| INDUSTRY OR BUSINESS: | At Home |
| AGE: | 79 Years, 1 Month, 14 Days |
| PLACE OF BIRTH: | Chicago, Illinois |
| NAME OF FATHER: | Louis H. Hippach |
| FATHER'S BIRTHPLACE: | Fon Du Lac, Wisconsin |
| MOTHER'S MAIDEN NAME: | Ida Fisher [sic: should be Ida Fischer] |
| MOTHER'S BIRTHPLACE: | Chicago, Illinois |
| INFORMANT: | Mrs. Jean Spalding Dutch Hollow Farm Middlebrook, Va. |
| DATE OF DEATH: | November 14, 1974 |
| CAUSE OF DEATH: | Metastatic Adenocarcinoma |
| INTERVAL FROM ONSET: | 2 Years |
| DUE TO: | Adenocarcinoma of Uterus |
| INTERVAL FROM ONSET: | 11 Years |
| SIGNIFICANT CONDITION: | Renal Failure |
| INTERVAL FROM ONSET: | 96 Hours |
| WHAT TEST CONFIRMED DIAGNOSIS?: | Surgery-biopsy-pathology |
| CERTIFICATION: | I hereby certify that I attended deceased from April 12, 1973, to November 14, 1974. I last saw her alive on November 14, 1974, death is said to have occurred on the date stated above at 4:45 AM. |
| PHYSICIAN: | Henry M. Putnam, MD Dedham, MA |
| PLACE OF BURIAL: | Rose Hill Cemetery Chicago, Illinois |
| DATE OF BURIAL: | November 16, 1974 |
| FUNERAL DIRECTOR: | Gordon L. Homer 160 W. Main St. Hyannis, MA. |
Comment and discuss