Here is the Death Certificate for my grandmother, Emily Kemp (Auble) Carringer (1899-1977), obtained from the San Diego County Department of Public Health Office:
Here is the transcription of the information in the death certificate (typed portions underlined, handwritten portions in italics):
CERTIFICATE OF DEATH
State of California - Department of Health
Office of the State Registrar of Vital Statistics
Local Registration District and Certificate Number: 8009 [blank]
1a. Name of Deceased - first Name: Emily
1b. Middle Name: Kemp
1c. Last Name: Carringer
2a. Date of Death: June 19, 1977
2b. Hour: 7:14 P.M.
3. Sex: Female
4. Color or Race: Cauc
5. Birthplace: Illinois
6. Date of Birth: August 19, 1899
7. Age: 77
8. Name and Birthplace of Father: Charles Auble: Canada
9. Maiden Name and Birthplace of Mother: Georgia Kemp; Canada
10. Citizen of What Country: USA
11. Social Security Number: 553-10-9373
12. Married, Never Married, Widowed, Divorced - Specify: Widowed
13. Name of Surviving Spouse: -
14. Last Occupation: Homemaker
15. Number of Years in this Occupation: 59
16. Name of Last Employing company or Firm: Self
17. Kind of Industry or Business: Own Home
18a. Place of Death: Doctors Hospital
18b. Street Address: 3475 Kenyon Street
18c. Inside City Corporate Limits?: Yes
18d. City or Town: San Diego
18e. County: San Diego
18f. Length of Stay in County of Death: 66 years
18g. Length of Stay in California: 66 years
19a. Usual Residence: 825 Harbor View Place
19b. Inside City Corporate Limits?: Yes
19c. City or Town: San Diego
19d. County: San Diego
19e. State: California
20. Name and Mailing Address of Informant: Betty Seaver, 2199 30th Street, San Diego, California, 92104
21a. Coroner: [blank]
21b. Physician [attendance]: From 6-18-77 To 6-19-77, last seen 6-19-77
21c. Physician or Coroner S?????, M.D.
21d. Date Signed: 6-20-77
21e. Address: 7930 Frost #401
21f. Physician's California License Number: G31180
22a. Specify Burial Entombment or Cremation: Cremation
22b. Date: 6-22-1977
23. Name of Cemetery or Crematory: Cypress View Crematory
24. Embalmer Signature and License Number: NOT EMBALMED
25. Name of Funeral Director: Cypress View Mortuary
26. Was Death Reported to Coroner?: No
27. Local Registrar Signature: John R. Philip M.D.
28. Date Received For Registration by Local Registrar: JUN 21 1977
29. Part I: Death Was Caused By: Immediate Cause: (A) Renal Failure
To, or as a Consequence of: (B) Myoglobenuria
To, or as a Consequence of: (C) C.V.A.
30. Part II: Other Significant Conditions: None
31. Was Operation or Biopsy Performed...: No
32a. Autopsy?: No
32b. If Yes, were findings considered?: [blank]
33. Specify Accident, Suicide or Homicide: [blank]
34. Place of Injury: [blank]
35. Injury at Work: [blank]
36a. Date of Injury: [blank]
36b. Hour: [blank]
37a. Place of Injury: [blank]
37b. Distance of Place of Injury to Usual Residence: [blank]
38. Were Laboratory Tests done for drugs or toxic chemicals?: [blank]
39. Were Laboratory Tests done for alcohol?: [blank]
40. Describe How Injury Occurred: [blank]
In the left margin, typed vertically:
This is to certify that, if bearing the Official Seal of the County of San Diego Department of Public Health, this is a true and correct copy of the original document filed. Fee paid $2.00
John R. Philip M.D.
County of San Diego Department of Public Health
1600 Pacific Hwy., San Diego, CA 92101
Dated: JUN 22 1977
The source citation for this death certificate is (using the Evidence Explained template for a Death Certificate, local level):
Emily Kemp Carringer certificate of death, Local Registration District 8009 (San Diego County), Local Certificate No. _____ (1977), County of San Diego Department of Public Health, San diego, California.
The only errors I see on this form are the birthplace of Emily's father - Charles Auble was born in New Jersey, not in Canada. Oh - one more, the County Public Health Department didn't put a local reference number on this form. The death certificate was obtained from the county for estate purposes.
As a result of this death certificate, I now know the cause of death, the contributing conditions, the attending physician's name, and the disposition of her body.
I was curious about the second and third causes of death - what is myoglobinuria? The definition is somewhat helpful - damaged muscles that leads to myoglobin in the urine which leads to kidney failure. And what is a C.V.A? A cerebrovascular accident - a stroke. So the stroke led to the myoglobinuria which lead to the renal failure and then to death.
Emily died in a hospital after being found on her living room floor, alive but incoherent, by her daughter and grandson following a stroke several days earlier. The attending doctor was on the hospital staff and had not treated her before. She died on her 59th wedding anniversary.
One more interesting fact: Emily's mother died in 1952, Emily died in 1977, and Emily's daughter, Betty, died in 2002. 25 years apart. Each was a beautiful person who lived a life devoted to their husbands, children, and grandchildren.
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Copyright (c) 2013, Randall J. Seaver