Death Certificate - France, Norman Elwood_1/20/1978r
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RECORD OF
DEATH
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PIKE COUNTY
DEP`�'RTflHENT 0� HE�I��
PETERSBURG, INDI�IIVA
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Tf�II_S IS TO CER1'IFY, tha[�our records show �\(C.+�'Y�^-�-�w�
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— , 1 � 7 � '��t�
mon da,y y-ear hour
.y 9 . n,�4s �P.� .��_-_ -�9
age sex wlor . � married or single
Primary cause of death gicen �cas l_ LC.:'{�;� \ r._��,��,Q�'�_s.�
' gigneci by V
yncian or
place of bLrial
�`1-
date of burial
cemetery
funeral
Ftecorded locfllly in book No. �1 a-� page No. �.3 �-
blling date
Petexsburg, Indittrza
_q_ `7�
Date. � �_%�_
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address
0
address
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Signed _
Pike County Health Comntisipner
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