Death Certificate - Beaven, George Richard_11/9/1979i----- LOCAL CERTIFIED CITY-COUNTY DEPARTMENT OF HEALTH RECORD OF DEATH c��y ,r e.•�o���u�—vanderburgE Counp Evan�ville, Indiana , N� i316 George Ricl,ard Beaven ' This is to Certify, that our rnordi shota•-----------------------'--'- ----'-"-------'--- died ----- Oct_ 29_ 1979 ---------------'t ------9 :40_am------- St'--�ry�-----------------°- mont6 dq �e�r huur o( dmA �trM, EpD���� � rvrq i30 ,� d1P W� lte married�- A�;e atdcath-"----- J`x---------- Cufor-------------'--'--------------------------------'-------- >�n �rite �hetEer murlN or dnti� undifferentiated bronchogenic carcinoma, small Primary cause of dnth giv�n was--------------'--------°------------'----'----------°-----'-'---- _______cell_type,__right_ lung___________ ------------------------------------------------ Si•nrdb D. ElshOff-----------------cit�'------------------------- ' � Y --------------------------- oe>.ki.o > ro.o�.. "'--'- .aa.� Barnetts Chapel Cem Elberfeld IN , Ylaie uf burial or removal-------'------------------'----'—' ---------- � ------'--- ---------°'-- , n.m. o� .vn.�.n .ea.�. 10-31-79 Simpson Volkman Elberfeld IN Datco( burial---'-'----'-'- "-------"- ------'-"-°---� ------------'°°--'------- v3�.�:i ui�«�o. wa.� tii�nad ----°---- `.�'�"�`_�'�--�t"d"'���-----Re istrar. -- Ei�ciiisi�il(r, Iit�ii rici ----11-2 _ 79--------- [sRnL� 44 e.e. --- [�O"CE: Recorded locally in Rook No. -------------- Page No. --------------• FEE $2.00 i � � 1 � � i