| STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS CERTIFICATE OF DEATH #138-78-003724 | |
| NAME OF DECEASED: | Helen Ragnild Ostby |
| SEX: | Female |
| DATE OF DEATH: | May 15, 1978 |
| RACE: | White |
| AGE: | 88 Years |
| DATE OF BIRTH: | 11/30/89 |
| PLACE OF DEATH: | Providence |
| NAME OF HOSPITAL: | Jane Brown |
| PLACE OF BIRTH: | Providence, R.I. |
| CITIZEN OF WHAT COUNTRY?: | USA |
| MARITAL STATUS: | Never Married |
| SOCIAL SECURITY #: | 035-30-1233 |
| USUAL OCCUPATION: | At Home |
| RESIDENCE ADDRESS: | 500 Angell St. Providence, R.I. 02905 |
| FATHER'S NAME: | Engelhart Cornelius Ostby |
| MOTHER'S NAME: | Elizabeth Macy Webster |
| INFORMANT: | Mrs. Ralph Anthony 17 Weymouth Ave. Providence, R.I. 02906 |
| DISPOSITION: | Cremation |
| CEMETERY: | Swan Point Providence, R.I. |
| FUNERAL DIRECTOR: | Drabble-Sherman 309 Benefit St. Providence, R.I. 02903 |
| CERTIFICATION: | To the best of my knowledge, death occurred at the time, date and place and due to the causes stated. |
| PHYSICIAN: | Daniel Lukowicz, M.D. Providence, R.I. |
| HOUR OF DEATH: | 4:06 P.M. |
| CAUSE OF DEATH: | Uremia |
| DURATION: | 1 Year |
| DUE TO: | Metabolic Acidosis |
| DURATION: | 1 Day |
| DUE TO: | Chronic Glomerulonephritis |
| AUTOPSY?: | Yes |
| WAS DEATH REFERRED TO MEDICAL EXAMINER?: | No |
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