Death Certificate: Susan Accelia Hendrixson, 1943: Kalama, Cowlitz County, 
Washington

Surnames: HENDRIXSON, VANDERHOOF, CONVERSE, DITLEVSEN, POTTER, ROACH 

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Contributor: DAS, Volunteer 0001015
<http://www.rootsweb.com/~archreg/vols/00005.html#0001015>
Contribution date: October 29, 2003
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Washington State Department of Health, Division of Vital Statistics
Certificate of Death

State File No.: 10
Registrar's No.: 2
 
 1. Place of Death:
  a. County: Cowlitz
  b. City or Town: Kalama, Rural
  c. Location: Rural
  d. Length of stay in community: 30 Yrs.
 
 2. Usual Residence of Deceased:
  a. State: Wash
  b. County: Cowlitz
  c. City or town: Kalama, Rural
  d. Street No.: Rural
 
 3a. Full Name: Susan Accelia HENDRIXSON
 3b. US Army, Navy, Marine Corps member? Blank
 3c. Social Security Number: Blank

 4. Sex: F
 5. Color or race: W
 6. Widowed (name and age of spouse left blank)
 7. Birth date of deceased: Mar. 19 1855
 8. Age: 87 Years, 9 Months, 16 Days
 9. Birthplace: Michigan
10. Usual Occupation: Housewife
11. Industry or business: --
12. Father Name: John VANDERHOOF
13. Father Birthplace: Penna.
14. Mother Maiden Name: Sarah CONVERSE
15. Mother Birthplace: Unknown
 
16a. Informant's own signature: Helen HENDRIXSON
16b. Address: Kalama, Wash.

17a. Burial
17b. Date thereof: --
17c. Place: Kalama, Wash.
 
18a. Signature of funeral director: Marguerite B. DITLEVSEN, Ditlevsen Funeral
18b. Address: Kelso, Wash.

19a. Date received local registrar: Jan. 8. 1953
19b. Registrar's signature: Elsie POTTER

Medical Certification:
20. Date of death: Jan. 5 1943, 3:30 PM

21. I hereby certify that I attended the deceased from 11/24, 1941 [November 24,
1941] to 1/5, 1943 [January 5, 1943]; that I last saw her alive on --, 1942, and
that death occurred on the date and hour stated above.

Immediate cause of death: mitral stenosis [looks like] and regurgitation
Other conditions: old age

Signature: L. S. ROACH, M.D.
Address: Kalama
Date signed: 1/8 '43 [January 8, 1943]


[Extractor's notes: Other documents suggest that Susan Accelia Vanderhoof was
more likely born around 1859-1860. Her first married surname was Windom; her
second married surname was Hendrixson.]