Death Certificate - Collins, Ivel Mark_7/3/1986LOCAL
ILECORD OF DEATH
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llAVIESS COUNTY
IiEALTH DEPAftTMENT
Court Aouse — �Veshington, Indiane 47501
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THIS IS TO CERTIFY, that our records show ------------Iv�l_Matk_CnLlins------------------------ died
hlarcl� 14 1986 17•52 p.m. Daviess County Hospital, Washington, Indiana
----- ------ at ----�------------------------------------------------------------
month day year hour of death street, haapital or rural
Sf m3le v?�� te Widrn:�
Age at death ----------- Sex ----------- color ---=°----------------------------------------------°-------
yeazs write whether married or ningle
Immediate cause of death given was ______cerebral vascular tl�x�osis
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Signed by ----Ibnalds.__flall.,_1d--Il---------------------------------�etrssh,�.-Sndiana-----------
physician or coroner addreas
Place of burial or removal ----S..O-Q.�'--CrlrnYeiy---------------------J.-'zzlstaa,__In.�;ana -------------
name of cemetery address
Date of bur{al �vx4_17,L48h--- --.Golxin_FSuaeraLlioa��-Inc-----�ruviceton,.-7lirliana------------
Funeral Director addreai
- Signed: __ ����U-Lu/�/ A=J_Ut7r1/1l�V,_L2��---------------------
� C'�� Davicss County Health Offlcer
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COURT HOUSE — Washington, Indtana 47501
Recorded locally in book No.__(1i_22_ Page No. _192_____ Date ___�vx.h_2fi�19IIfi___