Death Certificate - Blythe, Hassel C (Hack)_5/3/2001,
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VANDERBURGH COUNTY:HEALTH DEPARTMENT 21737
Room 127 Administration Building _- Civic Cerrter Car�Iex - One Northwest Martin Luthe� King Jr. 81vd.
- - Evansville, Indiana 47708-1828
CERTIFICATE OF DEATH REGISTRATION
�`l� (_ �er`i f 1eS �.- THAT ACCORDING TO THE RECORDS OF THE HEAL7H DEPARTMENT
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ruNE HASSEL C. ' HACK' BLY`PF�
DIEDIN VANDERBURGH COUNTY INDIANAON
10:15 P.M. MARRIED
TINE OF DEATH MPRtTAL STANS
$pCIAL SECURITY _ �
PLACE OF DEAiH ST . MARY' S MEDICAL CENTER �
AUGUST O1
SEX
MALE AGE H�
DATEOFBIFiTH 01/21/1916
PRIMARY CAUSE OF DEA771 GNEN WAS CANCER-METASTATIC ESOPHAGEAL CANCER
PIiYSICIANORCARONER THOMAS WAITS, M.D. Auroasv NO
PLACE OF BUFIAL OR REMOVAL SW INDIANA REGIONAL, DALE, IN
FUNERAL HOME LAMB-BP.§H.4M h�tORIAL CHAPEL
CERTIFlCATE NUMBER
OR VOLUME AND PAGE 00001573
YEAR zOOO
ancE WHITE
MANNER NATURAL DISEASE
DA7EOFBURIAL 08/Oi/2000
DATEISSUED OH/OH/ZOOO
NOT VALID UNLESS SIGNED 8 SEALED
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