______________________________________________________________________STATE OF OHIO - BUREAU OF VITAL STATISTICS - CERTIFICATE OF DEATH
PLACE OF DEATH.
County of Jefferson.... File No. 39826....
City of Steubenville....
FULL NAME Edward J. C. F. Meinzen
PERSONAL AND STATISTICAL PARTICULARS
COLOR OR RACE White
DATE OF BIRTH Mch 5 1879
AGE 32 years 8 months 10 days
OCCUPATION Stationary Engineer
NAME OF FATHER Henry Meinzen
BIRTHPLACE OF FATHER Germany
MAIDEN NAME OF MOTHER Elizabeth Armitage
BIRTHPLACE OF MOTHER England
THE ABOVE STATE PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
(Informant) Henry Meinzen [signature]
(Address) Steubenville Ohio
Filed Nov 16 1911 [rubber stamped]
[Illegible signature] Registrar
MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH Nov 15 1911
I HEREBY CERTIFY, That I attended deceased from Nov 14 1911.... that I last saw him alive on Nov. 14 1911 and that death occurred, on the date stated above, at 1 a.M. The CAUSE OF DEATH was as follows: Opium poisoning. Suicidal
14 hrs. (Duration)
Contributory Mental break down 2 years
(Signed) I. C. Foster M. D.
Nov 16 1911 (Address) Steubenville....
PLACE OF BURIAL OR REMOVAL Union Cemetry [sic]
DATE OF BURIAL Nov 17 1911
UNDERTAKER B. W. Mellenberger
______________________________________________________________________Notes and Comments
The undertaker's name was Mettenberger. It looks like he forgot to cross the "t's."