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Death Certificate - Douglas, John_11/21/1980� � ` LOCAL CERTIFIED GTY-COUNTY DEPARTMENT OF HfALTH _-•. � � RcCORD OF DEATH ... City of Evavsviile—Vanderburg6 Counr� � A70 �+(� - . Evanscille, Indiana . . lti • � a711�.7 � ' � • �' "' _' . .._ . '�. � .. : . . E :. . - - - . �C?uI DOUG� 4S - • e , _ . Thi; is to Cer,ifp, tha, o�r record; sho« --------- --- ----- ------ ---- -- ------------ died i �= CGT. .'.'..1 :1972 � "5:15 A.M. DPacon„ss " i —=- =_---_-`-= -_-_—.- ___ -=_--_=---.ac -----'------------=---- � ------------------------------' ' � � mon:u C�y " T¢az ." ' hOU: oS d0ath eirx0. hmyital� or rurnl " � � . .. . . .�- .. . . . . 1 _ . �. . _ ""'_ . ... .. . .. . _ � . _- . . . _�. :� ' :: ;:iale . ._ . :�.�h. --� 1;arried • ; '' =1ge at death------- Ses---------- Color-------------------------------------------=--------- ' . — . yecn " . . . . .. . wii:e ahe:hez merried or si�sle '" � i - • - � . '�_ - Fvinon=_r}- ins.�fficiencc :aith -;assive upper � . Primarv :zue of dea:h eieen �ca>--------------------------------------------=-----------=--- ' i . - . .. . . . . � . - . . ' i . �� . .� .... . . - . .'- . . �� - � Sb:O.T.:1i d�_ f!9!t;0^ih35°e E':r.,^,j:j'SE['13�- !?`10�32?I31 ll1C°I' �OVBi B .'�llii.0_flCCi�°Il� � ______"___'_ _"___'__ _ ' __'___'_"_ '______"'__'__"'_" '_ . __.. ,.: ..:..' _ __: . _ .__ . -------Sept. lst :�;it?� iraltipls fracb�i Signed by R.--F.—CarlSOri_ -. . ...' ---------------- �it5--------------------=-------- ' � , � . ph9sic en o 99�4.T9 � � . . . .. � , nd3reu . � . I . - IOOr _. . ` _ Francisco, Zr.d. I � Place o: burial o rem;;� 11 - -- ------ -- -------- =- -- ----- ------ - ----------- - � � ' ' ' name oC ecmetzry - � adErqs . ..., .�...--'1 : . ��' . __eddrese._ __,_ __'" ' ... 16-3-i2 Colvin. _.�. ' . Princ=tor., Zr,d. - Da.e of burial -----r�'i::%�_ _/'�� _%�v%CT��mDiC'�'. r%1%�'1�--R -- � -- -- 1- S i . �' �, . i L ' -, I .� Signea egistrar-. ' _ �, EUansvilie; �Indittiia �: _ .- ------��—�3-��------ : �se;:Lr �: ,;, �,' � ,; - . �� ' � - --- aaee . , .. : . - - -.._ .. . � =. � . -. .i. �. _ . ._ . .. . . . . "' ..� . . . -_,. . _ . � �. . �. __ Pa�e \o.----------- :vOTE: keco:ded Iocallg in Book \o. _______ 37 _ ' 196---• '; ,� � FEE $7.00 : � --- ---------------__..�._�.,...,._.,�,�.<.....,.n...,.,,,�.�,.�,�� , '�; � i a. q. �� a . �<�.. �,,.y.�:..o..ya.o..__°_•_---°--°---��-------- ; -.. ._.`. . . ...- . . � . � . : �_..__�___ _ , ` ' _ � . •�,' �.: : � : ; ti: ;- .� - _ ; R �