Death Certificate - Basey, Richard F_4/22/2002. .. 1�if..1 {, ,
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VANDERBURGH COUNTY HEALTH DEPARTMENT 2487'7
Room 127 Administration Building - Civic Center Complex - One Northwest Martin Luther King Jr. Blvd.
Evansville, Indiana 47708-1828
CERTIFICATE OF DEATH REGISTRATION
��jis �ertif ies, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPARTMENT
NAME RICHARD F. BASEY
DIEDIN VANDERBURGH COUNTY INOIANAON
TIMEOFDEATH OS:3S� A.M. MARITALSTATUS �`�RIED
SOCIAL SECURITV
PLACE OF DEATH DEACONESS HOSPITAL
PRIMARV CAUSE OF DEATH GIVEN WAS SEPSIS
MULTIPLE MYELOMA
OCTOBER 09
SEX �LE AGE 74
DAT[ OF BIRTFI 11/21/1925
PHYSICIANORCORONER THOMAS WAITS, M.D.
PLACE OF BURIAL OR REMOVAL COLUMBIA WHITE CHURCH
FUNERALHOM[ COLVIN FUNERAL HOME, PRINCETON, IN
C[RTIFICATE NUMBER
OR VOLUME AND PAGE OOOOZO41
AU70PSY NO
YEAR ZOOO
ance WHITE
MANNER NATURAL DISEASE
DATEOFBUr�IA� 1O�1z�2OOO
D�T[ISSUED 10/23/2000
Ny�7by�_UNC�S IC . e � �6p �)
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' VMIDEHOURGH C�UNTV HEALTM OFFIGER M.D.
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