This is a Message Board Post that is gatewayed to this mailing list. Surnames: DeLANEY, GLASGOW, HARRELL, HARROLD, HARRISON, OSBORNE Classification: Death Message Board URL: http://boards.ancestry.com/mbexec/msg/rw/Fi.2ADE/1204 Message Board Post: State of Ohio Department of Health Division of Vital Statistics CERTIFICATE OF DEATH 1. PLACE OF DEATH: County Darke Registration District No. 302 File No. 8666 Township Harrison [Inked Out] Primary Registration District No. 2317 Registered No. 6 Village New Madison No. Blank Street Blank Ward Blank City Blank Length of Residence in City or Town where death occurred Years Blank Months 18 Days Blank How Long in U.S. If of foreign birth? Blank 2. FULL NAME MARTIN E[ARL] HARRELL Residence Blank Did Deceased Serve in U.S. Navy or Army? Army PERSONAL AND STATISTICAL PARTICULARS 3. SEX Male 4. COLOR / RACE White 5. MARITAL STATUS Married 5a. SPOUSE Anna [Elizabeth DeLANEY] Harrell 6. DATE OF BIRTH Sept 8, 1889 7. AGE 44 Years, 04 Months, 29 Days OCCUPATION 8. Trade, Profession Physician 9. Industry in which work was done 9294 10. Date last worked @ Occupation Blank 11. Total years spent in Occupation Blank 12. BIRTHPLACE City or Town Blank State or Country Ind[iana] FATHER 13. Name Thomas [Tighlman] A[shley] Harrell 14. Birthplace City or Town Blank State or Country Ind[iana] MOTHER 15. Maiden Name Charlotte [Elizabeth] Harrison 16. Birthplace City or Town Blank State or Country Ind[iana] 17. INFORMANT O[tho] G[lenn] Harrell Address Kokomo, [Howard Co.] Ind[iana] RFD 18. BURIAL, CREMATION or REMOVAL Place Kokomo, [Howard Co.] Ind[iana Date Feb[ruary] 9, 1933 19. UNDERTAKER Stritz? & Sands Address New Madison, Ohio 19a. Was body embalmed Yes Embalmer's No. 1293a? 20. FILED Feb[ruary] 15, 1933 Signature Irene Mitchell - Registrar 21. DATE OF DEATH Feb. 7, 1933 22. I HEREBY CERTIFY, That I attended deceased from ____Blank___, 19__,to _____Blank_____, 19__. I last saw H__ alive on ____Blank_____, 19__. Death is said to have occurred on the date above at 9.30 a.m. The PRINCIPAL CAUSE OF DEATH and related causes of importance in order of onset were as follows: Accidental by taking an overdose of chloroform to relieve pain in chest CONTRIBUTORY CAUSES of importance not related to principal cause: BLANK Name of Operation: Blank Date of: Blank What test confirmed diagnosis? Blank 23. If death was due to external causes (violence) fill in also the following: Accident, suicide, or homicide? Blank Date of Injury Blank Where did injury occur? New Madison, Darke County, Ohio Specify whether injury occurred in industry, in home, or in public place: Home Manner of injury: Inhaling Chloroform Nature of injury: Blank 24. Was disease or injury in any way related to occupation of deceased? Blank If so, specify: Blank Signature: Raymond J Marke(r?s?), Coroner (M.D. is inked out) Date Blank Address Versailles, Ohio