Death Certificate - Brock, Richard R_6/19/2012CERTIFICATE OF DEATH
Local No
535859
74 �^� oan n� �v� O6/01/1937 OBLONG, IL
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HIGH SCHOOL GRADUATE OR GED
WAYNEBROCK
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520 S MAIN ST. PRINCETON. IN 47670
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JAMES RUSSELL FELTT , BY ELECTRONIC SIGNATURE � �er�+�+�s %n� ❑�«�+g ❑�+�
63. Na.x. n4tress MO LD CoCe IN Persm CeriM�9 Cause Of C��T: u. Lm�se MnDer �5. Ws Cct:SeE
JAMES RUSSELL FELTT . 406 N. 1ST STREET. P O BOX 806. VINCENNES, IN 47591 __ 01028953A 03/29/2012
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�� ATTENTIOV ESTATE: The Sodal Sewnry = is be�ng reauesrec oy U0s sfz.e agenq in ortler m pursue responsibLry_ DisWSUre ¢ vdun3ry a.�C there x+a Ee no penary ror re:usai.
NRA-20
(7/�)