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Here is an extract of the record:
Reg. Dist. No.: 475
Primary Reg. Dist. No.: 4719
State File No.: 23475
Registrar's No.: 3
1a. Place of Death, County: Guernsey
1b. Place of Death, City or Village: Richland Twp.
1c. Place of Death, Length of Stay: 2 yrs
2a. Usual Residence, State: Pa
2b. Usual Residence, County: Butler
2c. Usual Residence, City or Village: Emleton P.A.
3. Name of Deceased: Esther Gombash
4. Date of Death: 4-4-50 (04 Apr 1950)
5. Sex: Female
6. Color or Race: White
7. Married, Never Married, Widowed, Divorced: Widow
8. Date of Birth: Sept 22, 1874
9. Age: 76
10a. Usual Occupation: Housewife
10b. Kind of Business or Industry: Own Home
11. Birthplace: Austria Hungary
12. Citizen of What Country: USA
13. Father's Name: Charles Toth
14. Mother's Name: Mary Toth
17. Informant's Signature: Mrs. Michael Mayors (Julia Gombash)
18. Cause of Death, I. Disease or Condition Directly Leading to Death: (a) Aortic valvulitis, several years
18. Cause of Death, I. Disease or Condition Directly Leading to Death: Due To (b) Syphilis probably
20. Autopsy? No
22. I hereby certify that I attended the deceased from 3/7, 1950, to 4/2, 1950, and that death occured at 4:30pm, from the causes and on the date stated above.
23a. Signature: William W. Bryant MD
23b. Address: Senecaville, Ohio
23c. 4/14/50
24a. Burial, Cremation, Removal: Burial
24b. Date: April 7, 50
24c. Name of Cemetery or Crematory: Old Anadale
24d. Location: Anadale, PA
Name of Embalmer: Charles R. Corwin, (Lic. No.) 3164A
Date Rec'd By Local Reg.: Apr 19, 1950
Registrar's Signature: James Stevens
25. Funeral Director's Signature: Wayne D. Womer, Clintonville, PA, (Lic. No.) 3926
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