HomeMy WebLinkAbout1761 3 •
; . ,
If •
I '
t
t
~
I
~
F •
9
~
~
s
i
~ ~ _
~
~ 2'74134 a~`~~~~~ ~ouHTr F~~°?,
~ ~ R0~_r =c!~'R~S
HENRY COUNTY BOAR~ OF HEALTH ~~E~x ~s ~U" ~OURT
NEW CASTIE, INDIANA R~~,^,~."~ tiE~,'~!ED
, CERTIFICATE OF DEATH ~Z34PM'~~1 ~
~ _ FEe 6
• • •
~ t~ C~I P x f t~t P!3 ~ thct occording to ihe records of the He ry County HeoHh Department W
~ ' ~ ~
~ Name of deceased
.
~ Date of death ~'L a ~
~ ontb) (Day) (Yeory (Str~et, pitol or Rvron
- SEX COLOR OR RACE M/?R(t1ED NEVER MARRI~ ~ AGE If Under 1 Y~ar if Und~r 2! Houn
_ ~ I (In Ywn) /~p?~TH$ DAYS NRS. MIN.
~ ~ WIDOWEO DIVORCED (Specify) f _
~ 4 , ~ ~ ~
Primary cause of death given wcs
Y _ - yl'.~~ ~t,.
Certified by
or Cor r) s
~
~
Place of riqE~dj. J,~jp~ ' •
. ? ' .(Gmetery) nss) Kr
Date of~bJr~-~ ~7~?~,~~ifit~9ra) diredo
;-KS - ~ , • ~ . (Addr~ss)
~ Record w~ S fi~1C'.r ~ t 7 3 Book No. Pags No. ~
"
m` . • / J
4, , . ~ ~ ~ ~ Z7~~t
.
~ ' ~ ~ . .
, ~
. \ ~ _ H~olth Offiur
~ : ~
. ~ ~ .
. I~'`j
;-=a ~ _-'G £ : GE 1 lssued on ~ , 19
, _ ~„i•.r c,
_ ~i 1.