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Death Certificate - Clark, Richard W_2/2/1999--------- ,. ,� a _ . :. .. .. . . .. . . . .. , . . 23776 ° � � :' VANDERBURGH COUNTY HEALTH DEPARTMENT , � Room 127 Administration Building - Civic Center Complex - One Northwest Martin Luther King Jr. Blvd. , . � � ' ' Evansville, Indiana 47708=1828 � '�. ' � CERTIFICATE `OF DEATH REGISTRATION ;��ji8 �ertif ies,� . THAT ACCORDING TO THE RECORDS OF 7HE HEALTH DEPARTMENT ' I NAME RICHARD• W.i�CLARK� , . .• � �, �1 �� . . . � AUGUST 27 YEAR 1997 � . �� o,EO�N.�VANDERBURGH COUNTYi INOIANAON , ., .. .: ,, • �. , � , � :� 72 E4lHITE ''� 02:08 P.M. MARRIED_ sexMALE . nce anc , TIME OF �EAiH� ,� �� i ' MARITAL STA7US , � ' , . �� ; �� v . , ' OS/17/1925 � . SOCIAL SECURIN , , , , � � ,� ,. � DATE OF BIRTH . 1 . �� . . . . . � � ii . �� , i, - ' " ' PLACE OF DEATH'. DEAC�NESS H�SPITAL � � . � �; �� ;, � � � . . � �' ', . . :'1 ." RESPSRATORY FAILURE � � PRIMARY CAUSE OF DEATH GNEN WAS �NGESTIVE HEART FAILURE � � , . .. � � i. ' . . ,. . i; , ' . !' . ' , . � . . .. � , i, �� " � .t � i� 11 � �. , :� � �� AU70PSYNO � � � ' � PHYSICIAN OR CORONER THOMAS BROWNE, M. D. � � � � '+ . , ,. • ` „ u ' :• ,' " ' ' • ' ! � •� PLACE OF,BURIAL�OR REMOVAL. ST. ,JOSEPN, PRINCETON, IN, ., . r.uNNea NATURAL DISEASE � � ;, . ' �._: � ,. . r� FuNean�r+oMe 'CALVIN FUNERAL HOME; PRINCETON�IN DATEOFBURIALOS�3O��99� ; . . . �� ,� _ . , � v : , . ; ... `� , r� � CERTIFICATE NUMBER ' � � pqTE ISSUED Q9�O3� � 99� k -. ORVOLUMEANDPAGE OOOO�SSS �� . . . � y. . . . .. . . � . • . ' � �� NOT VAIJD UNLESS SIGNED 8 SEALED y . . ' . . ;. .. , •, ' , �; , . �. . , , � , y� ANpEPB�qGHC�Ep OFFICER `��