PERSONAL AND STATISTICAL
Bluferd Shipley
Place of Death: Fayette Co., OH,
Marion Township, Reg. Distric No. 4574
Residence: New Holland, Rt 1
Sex: Male
Color: White
Marital Status: Divorced
Spouse: Rebecca Shipley
Date of Birth:
Age: 81 years, 10 months, 20 days
Occupation: Retired Carpenter
Birthplace: Ohio
Name of father: Solmon Shipley
Birthplace: WV
Maiden name of mother: Francis Powell
Birthplace: WV
Informant: Aaron Shipley
Address: New Holland, OH
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MEDICAL CERTIFICATE OF DEATH
Date of Death: Jan 14, 1935
I hereby certify That I attended deceased
from Jan 14 1935 to Jan 14 1935
that I last saw him alive on Jan 14,1935
The cause of deth was as follows: Augnia Pertons
Was there any autopsy: No
Was test confired diagnosis: Aympton
Signed A.F. Kale, M.D.
1-15, 1935 New Holland, O
Place of Burial: New Holland
Date of Burial: 1-16,1935
Undertaker: A. W. ?, New Holland
Filed: 1-26, 1935 Robert V. Ware Registrar
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