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Death Certificate - Clark, David L_2/21/2002
; _ _ _. - ��_- _-�:�;:-_ ; ��, __ _ -�, - _ , - _ -- - - - �' - - -- - - ,. --. _- _ -- __ - - _�.-.._. - - - - --- --- - .., ;. : • � _ � . - _ -- -- - - - , ' ,- -- -- -- , -':-- - -- - - -- - - -.= _. -- = =:,__�:.-;,-=:�__� =_;.=_.:= _ _. =_:._'_. ._ . __ _.;_.-:.-:.-;�.�_-=,__-;.=„2-4 - -.: _:,-- . :_::--::-=:: - . _ -:.: VANDERBURGH _COUNTY,HEALTH DEPARTMENT-; -_O2 O4 Rooin 127 Administrahon Building -_ Civic Cente� Complex -- One Northwest Mariin Luther King J�. Blvd. - - - Evansville, lndians 4 7708-1 828 .- - - = CERTIFICATE -0F DEATH - �I,L� �Ql-"LLtLQ�� �- THATACCORDINGTOTHERECORDSOFTHEHEALTHDEPARTMENT' - _. DAVID L.=CLARK . .. - - : NAME ' �' .. ' . - _. . . DIEDIN VANDERBURGH_ COUNTY INDIANAON FEBRUARY OH. �EAR 2002 TIMEOFDEATH -11:39 A.M. MARITALSTATUS �RI� � SEX �I'F' AGE 70 qqCE �ITE SOCIALSECURITV 08/13/1931 DATE OF BIRTH �, PIACE OF DEATH ST . MARY' S HEDICAL CENTER PRIhU1RV CAUSE OF DEATH GIVEN WAS �SPIRATORY FAILURE _ CHE20NIC OBSTRUCTIVE PULMONARY DISEASE PHYSICL6VORCG�NFq JOHN POLIN, M.D. A�oPSy- NO P�qCEOFE�IiRIALORflEMOvqL IOOF� FRANCISCO�IN MANNER NATURAL DISEASE FUNERALHOME COL�IIN FUNERAL HOME, PRINCETON�IN - DATEOFBURIAL OZI�.2�ZOOZ ' � CERTIFICATE NU6IBER �ORVOLUMEANDPAGE �O0000302 - ' DATEISSUED OZ��.S�ZOOZ NOT VA�LID UNLESS SIG�ED 8 SEALED J � � ' — `� �[.j��il� rn.o. VANDEFBURGHCOUN MEALTHOFFICER