SINNETT
| HAZEL MARION McLEAN SINNETT
May 16, 1970 contributor: Richard A. McLean STATE OF OREGON--STATE BOARD OF HEALTH Vital Statistics Section CERTIFICATE OF DEATH 70-007711 State File Number 2762 Local File Number DECEASED--NAME First Middle Last 1. HAZEL MARION SINNETT DATE OF DEATH (month, day, year) 2. May 16, 1970 RACE White, Negro, American Indian, etc. (specify) 3. White SEX 4. Female AGE--Last birthday (years) 5a. 77 Under 1 year mos. days 5b. Under 1 day hours min. 5c. DATE OF BIRTH (month, day, year) 6. November 27, 1892 COUNTY OF DEATH 7a. Multnomah CITY, TOWN, OR LOCATION OF DEATH 7b. Portland Inside City Limits (specify yes or no) 7c. Yes HOSPITAL OR OTHER INSTITUTION-NAME (if not in either, give street and number) 7d. Providence Hospital STATE OF BIRTH (If not in U.S.A., name country) 8. Wisconsin CITIZEN OF WHAT COUNTRY 9. U.S. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED (specify) 10. Married NAME OF SPOUSE 11. Otis Sinnett SOCIAL SECURITY NUMBER 12. 544-07-7871 USUAL OCCUPATION (give kind of work done during most of working life, even if retired) 13a. Housewife KIND OF BUSINESS OR INDUSTRY 13b. Own Home RESIDENCE--STATE 14a. Oregon COUNTY 14b. Multnomah CITY, TOWN, OR LOCATION 14c. Portland Inside City Limits (specify yes or no) 14d. Yes STREET AND NUMBER OR R.F.D. 14e. 8101 S.E. Wing St. FATHER--NAME first middle last 15. John McLean MOTHER--Maiden Name first middle last 16. Elizabeth (Unknown) INFORMANT--NAME and relationship to deceased 17. Otis Sinnett - Husband PART I. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), and (c)) 18. Conditions, if any, which gave rise to immediate cause (a), stating the unde lying cause last approximate interval mmediate caus between onset and death (a) Myocardial decompensation, chronic severe 8 years due to, or as a consequence of: over (b) Arteriosclerotic heart disease 4 years due to, or as a consequence of: (c) PART II. OTHER SIGNIFICANT CONDITIONS: conditions contributing to death but not related to cause in Part I (a) Idiopathic thrombocytopenic purpura AUTOPSY (yes or no) 19a. No If YES were findings considered in determining cause of death 19b. ACCIDENT (specify yes or no) 20a. DATE OF INJURY (month, day, year) 20b. HOUR 20c. M. HOW INJURY OCCURRED (enter nature of injury in Part I or Part II, item 18) 20d. INJURY AT WORK (specify yes or no) 20e. PLACE OF INJURY at home, farm, street, factory, office bldg., etc. (specify) 20f. LOCATION (street or R.F.D. No., city or town, county, state) 20g. CERTIFICATION-- month day year PHYSICIAN: I attended the deceased from Feb. 18, 1969 21. TO month day year May 16, 1970 And Last Saw Him/Her Alive on: month day year May 15, 1970 I Did/Did Not iew the body after death (specify) Did not DEATH OCCURRED at the place, on the (hour) date, and, to the best of my knowledge, due to the 6:55 P:M. cause(s) stated. PHYSICIAN--SIGNATURE 22a. D J Molenkamp NAME (type or print) degree or Title 22b. D. J. Molenkamp M. D. DATE SIGNED (month, day, year) 22c. May 20, 1970 MAILING ADDRESS--PHYSICIAN street city or town state zip 23. 9501 S. E. Foster Rd. Portland, Oregon 97266 BURIAL, CREMATION, REMOVAL, MAUS. (specify) 24a. Burial CEMETERY OR CREMATORY--NAME 24b. Gethsemani LOCATION city or town state 24c. Portland Oregon DATE (mo., day, year) 24d. 5-19-70 FUNERAL DIRECTOR-SIGNATURE 25a. (unreadable) FUNERAL HOME--NAME AND ADDRESS (street, city or town, state, zip) 25b. Cascade Funeral Chapel, 9106 S.E.Foster Rd. Portland, Oregon 97266 REGISTRAR--SIGNATURE 26a. (unreadable) DATE RECEIVED BY LOCAL REGISTRAR 26b. MAY 25, 1970 DATE RECEIVED BY STATE REGISTRAR 27. JUN 1 1970 RESERVED FOR REGISTRAR'S USE 28.
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OTIS P. SINNETT
January 9, 1973 contributor: Richard A. McLean STATE OF OREGON--STATE BOARD OF HEALTH Vital Statistics Section CERTIFICATE OF DEATH '73-001097 State File Number 168 Local File Number DECEASED--NAME First Middle Last 1. OTIS P. SINNETT DATE OF DEATH (month, day, year) 2. January 9, 1973 RACE White, Negro, American Indian, etc. (specify) 3. White SEX 4. Male AGE--Last birthday (years) mos. days 5b.Under 1 day hours min. 5c. DATE OF BIRTH (month, day, year) 6. June 22, 1897 COUNTY OF DEATH 7a. Multnomah CITY, TOWN, OR LOCATION OF DEATH 7b. Portland inside City Limits (specify yes or no) 7c. Yes HOSPITAL OR OTHER INSTITUTION-NAME (if not in either, give street and number) 7d. Providence Hospital STATE OF BIRTH (If not in U.S.A., name country) 8. Washington CITIZEN OF WHAT COUNTRY 9. USA MARRIED, NEVER MARRIED, WIDOWED, DIVORCED (specify) 10. Widowed NAME OF SPOUSE 11. SOCIAL SECURITY NUMBER 12. 544-07-7871 USUAL OCCUPATION (give kind of work done during most of working life, even if retired) 13a. Equipment Maintance* KIND OF BUSINESS OR INDUSTRY 13b. Barwell Water District RESIDENCE--STATE 14a. Oregon COUNTY 14b. Clackamas CITY, TOWN, OR LOCATION 14c. Portland Inside City Limits (specify yes or no) 14d. No STREET AND NUMBER OR R.F.D. 14e. 8101 S.E. Wing St. FATHER--NAME first middle last 15. Unknown MOTHER--Maiden Name first middle last 16. Unknown INFORMANT--NAME and relationship to deceased 17. Clarence J. Graham, Executor PART I. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b), and (c)) 18. Conditions, if any, which gave rise to immediate cause (a), stating the under- lying cause last approximate interval immediate cause between onset and death (a) Pulmonary Congestion, acute 2 hours due to, or as a consequence of: (b) Myocardial decompensation, acute & chronic 4 years due to, or as a consequence of: (c) Arteriosclerotic cardiovascular disease 6 years PART II. OTHER SIGNIFICANT CONDITIONS: conditions contributing to death but not related to cause in Part I (a) Peptic ulcer, perforated AUTOPSY (yes or no) 19a. No If YES were findings considered in determining cause of death 19b. ACCIDENT (specify yes or no) 20a. DATE OF INJURY (month, day, year) 20b. HOUR 20c. M. HOW INJURY OCCURRED (enter nature of injury in Part I or Part II, item 18) 20d. INJURY AT WORK (specify yes or no) 20e. PLACE OF INJURY at home, farm, street, factory, office bldg., etc. (specify) 20f. LOCATION (street or R.F.D. No., city or town, county, state) 20g. CERTIFICATION-- month day year PHYSICIAN: I attended the deceased from 1/66 21. TO month day year 1/9/73 And Last Saw Him/Her Alive on: month day year 1/9/73 I Did/Did Not view the body after death (specify) Did DEATH OCCURRED at the place, on the (hour) date, and, to the best of my knowl- 10:00p.M. edge, due to the cause(s) stated. PHYSICIAN-SIGNATURE 22a. D J Molenkamp NAME (type or print) degree or Title 22b. D. J. Molenkamp M. D. DATE SIGNED (month, day, year) 22c. 1/15/73 MAILING ADDRESS--PHYSICIAN street city or town state zip 23. 9204 S. E. Mitchell Portland, Oregon 97266 BURIAL, CREMATION, REMOVAL, MAUS. (specify) 24a. Burial CEMETERY OR CREMATORY--NAME 24b. Gethsemani Cemetery LOCATION city or town state 24c. Portland, Oregon DATE (mo., day, year) 24d. Jan. 13. 73 FUNERAL DIRECTOR--SIGNATURE 25a. Eugene R Baldwin FUNERAL HOME--NAME AND ADDRESS (street, city or town, state, zip) 25b. Jacobson-Cascade Funeral Home, Portland, Oregon REGISTRAR--SIGNATURE 26a. (unreadable) DATE RECEIVED BY LOCAL REGISTRAR 26b. JAN 17 1973 DATE RECEIVED BY STATE REGISTRAR 27. JAN 23 1973 RESERVED FOR REGISTRAR'S USE 28. His birth date is variously given as: June 22, 1896 on the Social Security Death Index, June 22, 1897 on his Death Certificate, June 22, 1898 given by himself on his Social Security Application. His sister Jennie was born on May 22, 1896, so that rules out 1896. I am using the date given by himself on his Social Security Application. |