| CONNECTICUT STATE DEPARTMENT OF HEALTH PUBLIC HEALTH STATISTICS SECTION HARTFORD, CONNECTICUT, U.S.A. CERTIFIED COPY OF DEATH RECORD |
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|---|---|
| NAME OF DECEASED: | Annie Stengel |
| PLACE OF DEATH: | Newtown, Fairfield County |
| NAME OF HOSPITAL: | Fairfield State Hospital |
| LENGTH OF STAY: | 4 Days |
| USUAL RESIDENCE: | Norwalk, Fairfield County Connecticut |
| SEX: | Female |
| RACE: | White |
| MARITAL STATUS: | Widowed |
| HUSBAND'S NAME: | Charles Stengel |
| USUAL OCCUPATION: | Housewife |
| INDUSTRY OR BUSINESS: | Own Home |
| DATE OF BIRTH: | May 2, 1867 |
| AGE: | 88 Years |
| PLACE OF BIRTH: | Brooklyn, New York |
| NAME OF FATHER: | Charles Morris |
| FATHER'S BIRTHPLACE: | Danbury, Connecticut |
| MOTHER'S MAIDEN NAME: | Amanda Ripley |
| MOTHER'S BIRTHPLACE: | Connecticut |
| INFORMANT: | Fairfield State Hospital Records |
| DATE OF DEATH: | January 22, 1956 |
| CAUSE OF DEATH: | Bronchopneumonia |
| INTERVAL FROM ONSET: | 1 Day |
| DUE TO: | General and cerebral arterio-sclerosis. |
| INTERVAL FROM ONSET: | Years |
| WAS AUTOPSY PERFORMED?: | Yes |
| CERTIFICATION: | I hereby certify that I attended the deceased from January 18, 1956 to January 22, 1956, that I last saw the deceased alive on January 21, 1956 and that death is said to have occurred on January 22, 1956 at 1:30 AM. |
| PHYSICIAN: | H. L. Clow, MD Newtown, Connecticut |
| UNDERTAKER: | Milton Kiely 70 N. Main St. South Norwalk, Conn. |
| PLACE OF BURIAL: | Fairmont Cemetery Newark, New Jersey |
| DATE OF REMOVAL: | January 23, 1956 |
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