Lily Alexenia Potter (Death Certificate)

COMMONWEALTH OF PENNSYLVANIA 
DEPARTMENT OF HEALTH 
BUREAU OF VITAL STATISTICS CERTIFICATE OF DEATH # 8072 
NAME OF DECEASED: Lily A. Potter
PLACE OF DEATH:  Cambridge Apts.
Alden Park, Philadelphia, PA
USUAL PLACE OF RESIDENCE:  Cambridge Apts.
Alden Park Manor
Philadelphia, PA.
SEX: Female
COLOR OR RACE: White
MARITAL STATUS: Widow
USUAL OCCUPATION: Housewife
DATE OF BIRTH: August 15, 1855
PLACE OF BIRTH: Penn, Michigan
AGE: 98 Years
CITIZEN OF WHAT COUNTRY?: USA
FATHER'S NAME: Seth Nyle Wilson
MOTHER'S MAIDEN NAME: Martha A. Thompson
INFORMANT:  Olive Potter Crolius
Cambridge Apts.
DATE OF DEATH: January 1, 1954
CAUSE OF DEATH:  Chronic Myocarditis &
Decomposition
INTERVAL FROM ONSET: One Week
ANTECEDENT CAUSES: General Arteriosclerosis
INTERVAL FROM ONSET: Years
CERTIFICATION:         I hereby certify that I attended
the deceased from December 25,
1953 to January 1, 1954, that I
last saw the deceased alive on
December 31, 1953 and that death
occurred at 9:45 A.M. EST from
the causes and on the date
stated above.
SIGNATURE OF PHYSICIAN:  Josephus T. Ullom, M.D.
160 Carpenter Lane
PLACE OF BURIAL:  Laurel Hill
Philadelphia, PA
DATE OF BURIAL: January 4, 1954
FUNERAL DIRECTOR:    John R. Henderson
6301 Gtn. Ave.
Philadelphia, PA
(Kirk & Nice)

Related Biographies:

Lily Alexenia Potter

Acknowledgements

Phillip Gowan

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Copyright © 1996-2019 Encyclopedia Titanica (www.encyclopedia-titanica.org) and third parties (ref: #20945, published 28 August 2003, generated 18th June 2019 06:45:01 AM)
URL : https://www.encyclopedia-titanica.org/death-certificate-20945-107.html