Death Certificate - Chavis, Delbert_4/24/2003, �.:; .. �. .
VANDERBIJRGH COUNTY HEALTH DEPARTIVIENT 11530
Rown 127 Administration Building - Civic Center Canplex - One Nathwest Martin Luther King Jr. Blvd.
. Evaruville, Indiana 47708-1828
CERTIFICATE OF DEATH
��ji8 �ertif iee, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPAFTMENT
NAME DELBERT CHAVIS
DIEDIN VANDERBURGH COUNTY INDIANAON NOVEMBER 17 �EAR zooa
, 71MEOFDEATH O�I:O�J P.M. MARITALSTATUS �RIED sex �i'E AGE 81 qqCE B�CK
SOCIALSECURITV DA7EOFBIFTH 11/19/1920
PLACE OF DEATH DEACONESS HOSPITAL
� PRIMARV CAUSE OF DEATH GIVEN WAS RUPTURED ABDOMINAL AORTIC ANEURYSM
PHVSICIAN OR CORONER SANTI VIBUL � M. D. AUTOPSV NO
PLACE OF BURIAL OR REMOVAL SAND HILL CEM. , PRINCETON, IN MANNER NATURAL DISEASE
FUNERALHOME COLVIN FUNERAL HOME, PRINCETON,IN DA7'EOFBURIAL 11/21/2002
CERTIFICATE NUMBE-R
O� VOLUME AND PAGL
00002321 DAT[IuSUED 12/02/2002
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