Death Certificate - Burton, Charles Roy_4/5/1994�
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23964 �
� VANDERBURGH COUNTY HEALTH DEPARTMENT
i Room 127 Adminisfrafion Building - Civic Cenfer Complex - One Norfhwest Martin Luther King Jr. Blvd. i
1 Evansville, Indiana 47708-1828 I
• CERTIFICATE OF DEATH REGISTRATION •
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! THAT ACCORDING TO TME RECOROS OF THE HEALTH �EPARTMENT �
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� NAME CHARLES ROY BURTON �
iDIED IN VANDERBURGH COUNTY INDIANA ON JANUA1tY OS �EAq 1993 i
iTIME OF DEATH O21 OO A.M. MARITAL STAIUS DIVORCEU SE% M�I'E AGE 84 RACE WIIITE i
ISOCIAL SECURITY DATE OF BIRTH 11/2G/1908 ,o •
IVLACE OF DEATH ST . P1ARY' S MEDICAL CENTER I
IPRIMARY CAUSE OF DEATH GIVEN WAS PERITONITIS I
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PHVSICIAN OR CORONER DAVIU J. CARLSON., M.D. AUTOPSV NO �
Iv�nce oF euaia� oR ReMOVn� PROVIDENCE CEMETERY MANNEH NATORAL UISEASE !
IFuNean� Ho�ne �- 'CORN MORTUARY, OAKLANU CITY,IN 47660 DATE OF BURIAL O1/09I1993 !
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' CER'fIFICATE NUMBER ' �
! " OR VOLUME AND.PAGE'- 'OOOOOIOJ DATE ISSUED 04IOSI1994 �
' ' � � NOT VALID UNESS SIGNED 8 SEALED i
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cAPR 05 1994
��y � AUDITOR�s