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; ELKHART C~UNTY HEALTH UNIT ~~~r: ~~U~~
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~ THIS IS TO CERTIFY, that our records show .................Wal lace C. Manro~ died
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; ~---...-Tu-1-3-'----- ----------•--23-- - -------.1965------ at...----.7.:.0.5...A_.M•.---------~~---........._..... Goshen General Hospi_tal
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Month Oay Year Hour of Death Street, Hospital or Rural
i Married.._XXX..---------- Widowed,.
' Age at death ...-----...77.....--~--~ Sex ..Male------. Single Divorced
~ _ Years
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~ Primary cause of death given was Arteri.o_scl.eroti_c___.heart__._di sease._.___..___..
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~ Signed bY •-Rober t._..A_r.....Cra ig D' - . -~---~----._..........._SY..i'.acu Ge_~.._..I ndi ana
Physician or Coroner Address
~ Place of bur~al or removal ....._.......Violet.t . Goshen Indiana
~ Name of Cemetery Address
- Ju 1.Y.....26..~.....196.5_.. _.Y~der..-.Cu lp... - - ~ Go ~h~n.,..__I n.di ~na...
• Date of Burial Funeral Director Address
~ ~ ' tSEAU S~gned - M. D.
~ . ~ - . Cammissioner of Health
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. . ..---......._....~<ZS.h~.n......_ . Indiana. ...._........_.....F~bru~rY.....7...s.....?.9..7._4.......-•---...... .
, - • Date
~ Recorded locally ......G65-_275
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7-27-65 _ . , T9--~--
When filed _ .
~f-~ 224 F,~E 39 3
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