Amended Certificate of Death, Ohio Department of Health, Division of Vital Statistics, Reg. Dist. No. 62, Primary Reg. Dist. No. 6201, Registrar's No. 146.
1. Place of Death: a. County, Ottawa, b. City, Port Clinton, c. Length of stay in 1a., 82 years, d. Name of hospital, Magruder Hospital, d. Place of death inside city limits?, yes.
2. Usual residence: a. State, Ohio, b. County, Ottawa, c. City, Port Clinton d. Street address, 317 Jackson Street e. Is residence inside city limits?, yes f. Is residence on a farm?, no
3. Name of Deceased: Dorothea Marie Tadsen
4. Date of Death: 1 November 1963
5. Sex, Female
6. Color, white
7. Married
8. Date of Birth, 20 September 1881
9. Age in years lastbirthday, 82
10.a. Usual occupation, Retired Housewife
10.b. Kind of business or industry, Own home
11. Birthplace, Ohio
12. Citizen of What Country, U.S.
13. Father's Name, Lawrence Lorenzen
14. Mother's Name, Kathryn Kruse
15. Was deceased ever in U.S. Armed Forces?, No
16. Social Security No., 295 01 5501 17.
Informant's Name, Eunice Rader, Niles, Ohio
18. Cause of Death: Death was caused by Terminal Pneumonia (Interval between onset and death- 4 days) due to Uremia (interval between onset and death-1 week) due to Intertrochhanteric Fx Rt. Hip (Interval between onset and death-1 week)
19. Was autopsy performed?, no
20a. Accident
20 b. Describe how injury occurred, fell at home (Residence)
20c. Time of injury, 10:00 A.M., 25 October 1963
20d. Injury ocurred, Not while at work
20e. Place of injury, Home
20f. City, County, State; Port Clinton, Ottawa, Ohio
21. I attended the deceased from 28 October 1963 to 1 November 1963 and last saw her alive on 1 November 1963. Death occurred at 7:40 A.M.
22a. Signature, Kraft Ritter M.D.
22b. Address, 232 E. 2nd St., Port Clinton, Ohio
22c. Date signed, 3 December 1963
23a. Burial
23b. Date, 4 November1963
23c. Name of Cemetery, Lakeview Cemetery
23d. Location, Port Clinton, Ohio
24. Name of Embalmer, Richard O. Wolf (Lic. No. 4960A)
25. Funeral Director's Signature, Richard O. Wolf (Lic. No. 3735)
26. Funeral Firm and Address, Gerner and Wolf, 216 Washington St., Port Clinton, Ohio
27. Date Rec'd by Local Reg., 5 December 1963
28. Registrar's Signature, Gaile Stevens
29. Date Rec'd by Sub-Registrar, blank
30. Sub-registrar's Signature, blank.