HomeMy WebLinkAbout1415 a«S~
25C~8'70 ~ f L~°~`~; ~
~.~~,K C U11 C~U~t~'
~C•l;, r ~:..~...-r~
~ N+~t 30 'L v~ fM'~3
2508'70
;
. .
;
_ ~
~
~
. CLAY COUNTY HEALTH DEPARTMENT ~
~ BRAZIL. iNDtANA ~
~
CERTIFICATE OF DEATH
;
;
,
ie;l2is (G~srtifiss the official records of this department ahow the following:
~
,~.~e Ben jamin Franklin Fugate A~ 74 ~ Male ^ ~n~ Qg ~,gte ?
Brazil, Indiana ~ wiaowed p Divorced p
Place of deatt~_C1ayMCounty Hospital ___~ate of death.__ ~anuary 1970
Cause of deatlL.~_ Brain Tumor s
-
. Bronchopneumonia
Signed by_Robert I~. Naurer, M. D. ~_Date of buriaL__J
_anuary 9, 1970
(Ph~nlolan, YdfdHf •--------------w_~_....._------
Funeral Hom~~?-awson~ Inc. M__ .___~_.Addresa... Brazil,~ Indianaw_~___._________
~
Name of Cemetery Roselawn T~!emorial Park Aa~_ North of Terre Haute Indiana '
.w___________________._ '
Date issuecL__ Janusry 9~ 1970 Book No.____l~-_--_------- Pa 1 `
Se-----------------------
,•..s,~~,,,
j 1'~ ~ ~ s ~,''~~j~ • _
~ ~.s..M, ~S'I.?
~s~l f . 5+~~---~r . _ G1'L .
; S~ ; = M~/l1TM ORF1Ct~~
!?3 S ~ ; • ~
' 't i •
•
,t~-y~~, II~ (ias~Ltl ~YIaL~ ~
~ ~
a!!:.~. . ; -'.~'Q` ` :
:
~'r ~~~~..~~'.~~~ti``=`~ #
is, _
~~~ij{ Tt i
'~~~~~~li?Ni~NHriN i
;
i
!
3
i
;
a
F
~
a
f
. ~
;
t
t
~
~
d~ ~'12 ~i4i5
: ~
~ -