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Death Certificate - Anslinger, Grace_6/25/1999FO " "' . . __ •" _ _"—_ _ � �.. .
INI
DEATH VERIFICATION
DKE/SED--NAME �iur �i�ou ', wr SIX DATE OF D'AiH ��o+rn, o�t, ruu
� -� GRACE ANSLIl1G R �. � Janura 2 1
RACE r+�*�. ��e�o, e+enu.n ixa�u�, AGE-un u.ou � rw v.ou � en DATE OF BIR1H woern, owr. COUNiY OF DFATH
[iG UIIGIT ��t(M{�i' I�NYI y0f. DAii MOVIf YIM. lUll
� i9htte s�.. sb. s�. s.�'eb.6 1888 �a. J
CITY,TOWN,ORLOUTIONOFDE/.iH �esmianu.in HOSGITFLOflOTMEflINSiITUIION-w�Mno�innr/«./^^^^ IFHOSP.ORINST.ina�ovoon.
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�. Lout�vtlle ,�.�e� �a.���arkwa '�edtca2 Center �..
'� •• '' �' :iATE OF BIRiHm�onxue.n.. CIiIZEN OF WMAT COUNTR MARRIED. NEVER M�.R61ED, SURVI`/14G SPOUSE urwve.emuue�.wwuu
MGUI COVMilO W I DOW ED. DIVOICED un<un
::'.�,���..a Inde U.�S.A.
�.� e¢uso _. a. ta. !•Ii u.
��u, v eum gp��� SKUBI7Y NUM0E0. USUAL OCCUPAiION wn[ n�o or wo�v eo�t ovn+e uor. or KIND OF BUSINES$ OR INDUSTRY
%CV��I] IX WOl[IMG IYG It IRI�F'Jl
�Si1:Vil0M. GIR IvTA I�. 136 �l i.�� £
KSIOI�C� 1l1011 ��• 1 O1190W.1fE
�mmox. NFSIDENCE—SiA7E COUNTY CIiY, TOWN. OR LOUTION iwua�anuu�n STREEf AYD NUMBER
lS1!<IIT ili Ol NOI
�—� ,�a. Ind. „b. Gibson �k•F a �+a. r* �+.. R.R.2
�:HEd-7lAME nasi uieeu twsr MOiHER-MAfDEN NAME nui �mou twsi
- "' Joseph Eble ,a. CarolinH
.: JxMANT�7AME MAILING ADDRBS tnun o� �.r�. Mo., un o� row�. nwn. xv�
,�,.I,inus Psislinger ��b. R.R.2 Ft.Branch Indiana ^
n�Cnu�.E IMitvLL
PARi I. DEATH WAS UUSED 6Y: [EMER ONCY ONE CAUSE PfR LINE fOR (a), (6), AND (<Jl �R,�,«� � rt �
19. i..tmnu uust`� �� '
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{iAi1MG iM[ Uw'il�- OVf tOr C{ AS A COx3(OVtMG OI: ,
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q�QpSY WAS CASE REFERREO TO MEOIC
IA[i II. OtHE4 SIGNIFi(Alli CONDIilONS: coMmuowi mMnumtec to ourH �m Mot uurzo to c�au cn�v �w un �{a) (y.,e, „e' EXAMINER OR COFONER
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ACC.. SU�C�OE. HOAt.. U4DET:, DAiE O: INJURT I�o+�n, e�r, ruq HOVt MOW IHJULT OCCVR[E� ItMm M�iuu oi IM���1 w u�t�i 1 O� �ui 14 rteu ul
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INJUI� Ai WO2[ �UCE OF IHJU4T Ai MO+l, r.w1. siun. MOU LOUTION . ISnlli Ol �.rA. MO., art Ol i0+�, aAnl //
Isr�uq .ru ot eol on¢e �ue r.e Isr¢ml l �..' �/•� � �� - �� L-Y,f��� `✓'J
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ERIIHUiION— uoxrn >wr ru� .o.m owr tw a�o n�wnowrnuwT�`o. io�/oMia�eur��n� � ouu�cV��ue.n�u�o.torwevsr
fNTSICIAl1: 7 / '7 / Oi �t [howuxR ov1
I �nwom r�e � /�i -� IIb.. r.s /l ile. � �.�7' �% Zld. Zle. M.ro rHe e.vselsl nerzo.
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CE0.TIFIUTIOY—MEDIUL EX/�M�NER OR CORONER: w r�t vsii or r� nov� or curn r�� o Yu�urt wu r�o+ou.�T oua � Hou�
QAY�MAiIOM O/ iMf �001 /.M]/Ol IM� IMr(Si1GAilOn. IM Yl O�IMIOM, _
ou�w oceu..n ox ixe owrt �.a e�� ro r�e uusels) R���. µ�y M•
nO' SIGNATURE oww oa nju D/�TE SIGNED �.oMix, wr, ruu
' CERTIFIER-NAh1E mn o� nyn � . ;:
.. ne. ✓rr,� f/.(� :�,'�frrl:i- nb. � :.•1>� ;1:�_�>� /i.,Gs�L�,�/_�� z3�
•iiY:i Ot LlA. M0. ' <IR Oa iOwM
(fAi! 1��
MAlLIN6 ADDRF55-CERTIf1ER � .. � f� �i� C!! 7-c�Y
d. .y-7C �%/�?./ %i%� �v:/%n ..;.-/��t�./ �� -/A/✓. �!�. �'_
UiT Ol iOWM nAn
BU0.1AL, C0.iMAilON, REMOYAL CF.NETERY OR CREAUTORY-NAMF LOUTION .
iarK�m Bll7'L61 t�b. •St. Ber�riard Cemeter tk. r n h ' -
2/a. / 51 IV�ODEI OF FUNERAL HOME
. n�ic ��e.*w_vai.ruu FUNER/�LDI0.EROR�IGNATURE _ _' '. � _.. _._ z!14+d....., L']L.I.A
_'_." —
� . _ _ ._—_ ... _. ._ .' _" ___. _. ... ._ ._
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The information given above was copied from the certilicate of death which was /iled wit
�me for transmittal to the Depa�rment for Human Resources for.registration as provided 6y KRS. 213.
Certilied copies of the olficial death certificaie may be obtained f�om the Office of Vital Statist�
, � Oepartment for1979 an Resou�ces, 275 East Main Street, Frankfor�kY for a f o lt:
fEB 6
� Local egistrar
pate
7$�$$. "'�_County Nealth Department BY: eputy egistrar
I[AUisville, �'. Rencucky Form VS-705 (Rev. 1/75)
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