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HomeMy WebLinkAbout2380 . - . . - - - - - - - _ ~r ~ ~ TME HEALTN AND HOSPITAL CORPORATiON OF MARION COUNTY ~ . wvIS1oN OF PUBLtC HEJ?LTH F~E ~ OOLLAR t ~ ; ~I~~~/~ ~ )a41 CITY-COUNTY BUIt_DING - iND1ANAPOLIS. INO. NYMKR N{OTOaTA7R YAO! ? 1~.t~ c CERTII~tED COPY O!r RECORD O!r DEATH OIr ~ t 0 ~ ~ ruw~ of occcwaca ~ua M. l3sber AATt O/ QtATH~~l~_31.~ 1~~ ~ Pt~C[ OF DEATH, GOUNTY~ MARION GITY. TOWN, OR {.OCATIf+u i Il~i=~Q~.is L IDGi~1l~ ~ M~Mq ~ h. M~1Mt N~p. ~ WIOONtCI~ ift1/Q MAhR. ? ~ ~ YW.' OAff ~ Na. ~ MIN. _ e~ Fefsle _ .i.~u.~.w o wvo~ew ~wr~ or e~RT,~ 1••1~18aa „~c FATFi[R'S NAM~ ~~A Y~ wOTHEII'i MAIDEN NAM O1;K M~ RObEZt~OQ ' INT[RVAt ~[TYIIL[M cwuu of ofwTH ~ ~ • PART 1. IMMtD1ATE CAUS[ tA) ~CI1i~~O~ ~ toNWttoHf. t~ wwY DUt TO t9) ~ ~ iMMIGN YIV't Rif~ TO ~1 w~o~r~ u?uu cw) ~ ~r~~~wo nre vwo~R. ~ ~rtiN wVrs u~l'. DU[ TO tC) - ~ OTH[II NONIi1CANf GONDITfONi CONTf11~1lTlNO TO DiA1N W/ NOT RLLI1TiD TO Tttt ?[OMINAL 011[Aii CONO~SION alVtlt IN PART ~ 1A1 ~ PART 1~Lnw ~ n,~~igaiew - D/1T[ OF 6URtM ~~~_~..?r 1~1 ~CEM[T[NY r=~n ~rt _~.oc~T~ow Portltnd~ Iadiluia ~t v~o~.~, wr o' wac r+~h?g.._._ DEATM GEllTlil[O YY~B~L M~a~e2~~rdl. M.D_ ~ NOT VAUD UNLESS MACHlNE NUMBERED _=s o~~ F~~~ a. i~x ~ AND S!GlJED WITii MUITfCOtOR RIBBON o~nt ~saucc~ - .1D• ~9'f2 _ _ . . . - - _ . ~~i - ~ ~ . ~ _ NUMiiRlO ~ B. t~ad~liCt ' ` ~ _ ' ' ~ ~ ; / ~ ~RK " ' % . p ` . • i ~ ~ ~~Vlt . t~I L~~ _1 ~ i_ TNRU ~ ~ ~~T Yr~'E' v 1t ~11 Y f LA~ . . . - . . ~ ; ~ ~ ~ ~ ttUGc: p~~;RAS ~ . . . _ - ~ - / / , ' ~ ~ CLEF'K C~R"+ull COti~T 'r ` - ' ~s' ; ~ A~GOA1~ vEf;+itEfl~ . . ~ a ; , ; ~ ~y~~ oie~toti o? wxtc ~w~t~t ~ ~ f ~ ~~o,~~ ~ ~ ~ ~ ~ t y:.~. ~~e._.__ _vv _ ~ ~ * _ ~