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Death Certificate - Cleveland, William Ralph_11/3/1977� � � . �o.��uua �,ti` LOCAL CERTIFIED .� CITY-COUNTY DEPARTMENT� OF HEALTH � r RECORD OF DEATH c�h of Evamville-_ V�odxburgh Count� � .., - , � . ' N° 1617: F' _ \ � E��a.ville. Indi�na � s �-� ._ •!! ... . � � � . i.�. •' ' . '.. ' . I , � ,''' WILLIAM RALPH CLEVELAND. � . . - •... ; � -. � �Th�s is to CerUfy that our records show _ ___________ _______ __ ___ _ - � -- ---- I :.. OCT. , 2= 1977 � 8:45 A M Deaconess ---------- --- ,-_ _ f. . --------- --- at------- ` . .. . mont6 - - " eour or Ce,te '-----� -- ----'- � �. ..d'1 >ear . '__'__""'___" - - . ' md - � . - - . - �treet,' hnpital w rvtd ; �. ' 74 � Male. � Wh Married' ` '• � .. Age at death-: ----- Sex---------- Color--------- . . . ' . ;. �. ti:: � .. � �. �? . ,.1wn . ' .. '__"'_ • ' - . '_'____'___"_____ " __'_""____ ori4 whether merried or �ina�� s - . -- . � , ; _ , . -, . ... .� , ' •�^' Debility — chronic brain syndrome •' � -= . •'��Primary cause�of drath given was_________________ - � � „. , _ � ' � ---------------:---- ' �� ------------------- ' � • -------=-- •�' > : � �'�< �� _ _, ..:.arteriosclerosis ., .. • - - --------------------'--y .. -------------------------'---- ' Signed by --T -A --SOUTH ---------- . ' . . . . Pose vi-11e', Ind. ' • •t. . . . ." Phnicia�� ___'_""_""_'_'_"_" '_'__'__'_'__'___'_'__'__ - ' . . . , � � Wdrs� . "_"'___' ' " ` Mt. Mariah � Ft.Branch, Ind. � ?..' .,..Place �of buii�l �or removal------------------------------- � . :.. : . . '. � ' -. .. • . � . n.me of caneten "_"___ -. _ . -10-4-77 Wade � -------s` ----------------. ,. .' t Date b ' Haubstadt; 'Ind. � al ------------- --- .: . :.:, �. . ;� ---�n�..i n�. '-------- --------------.aa.a. -- eo . . ,:.: . � �,� �-- - � ------------- .. . . . � Signed - ------- ' -=--------Registrar. , .. • _ . • , '.. 6 ------------ ' l -- , . .. ...:' �" Ev ille, Indiana' . �0-�-7� --_ [sEni� Op " . ___________�4 _�.___' . . _ . .: � . , . _ .. �. . C • - 42 � . :..: .. g � NOTE: Recoided locally iq Book No. -=------------ page A`o. ---- --�- : .- . � g � . - ------. . FEE $2.00 p "„�,...,,e........._..�----------- - ----�------ — . . . - - - : - -- — . - < .- - -- — - -, - _ I - � . • �