Death Certificate - Fields, Tom_2/20/2009�
•
�
�
�
�
VANDERBURGH COUMTY HEALT�1 DEPARTMENT 14896
Room 727 Administration Building - Civic CeNer Comp/ex - One Northwest Martin Luther King Jr. Blvd.
Evansvil/c�, Indiana 47708-1828
CERTIFICATE OF DEATH REGISTRATION
��ji8 �ertif ies, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPARTMENT
_ � I
I
NAME TOM FIELDS
DIEDIN VANDERBURGH COUNTY ��,o,AN,.oN
TIMEOFDEATH OJ:OO A.M. MARITAISTATUS �RIED
SOCIAL SECURITY
PLACE OF DEATH DEACONESS HOSPITAL
AU�1ST 30
SEX �I'E AGE S3
DA7E OF BIRTH
PRIMARV CAUSE OF DEATH GIVEN WAS CANCER—METASTATIC PANCREATIC CANCER
PHVSICIAN OR CORONER DANIEL SHIREY, M. D.
AUTOPSV NO
VEAR 1998
FACE WHITE
PLACEOFBURIALORREMOVAL WALNUT HILL CE?i.,FT.BRANCH�IN MANNER NATURAL DISEASE
FUNERAL HOME STODGHILL FUNERAI, HOME, FT BRANCH� IN DATE OF BURIAL O9�OZ�Z��9H
CERTIFICA7E NUMBEF
ORVOLUMEANDPAGE 00001726 DATEISSUED p9/11/1998
NOT VALID UNLESS SIGNED 8 SEALED
L r"" 7� c i� ' y.i�
� �. �.�1.��.4J.• ��'t// �(
�/-�� M.O:
VANDERBURGH COUNTY HEA H OFFICf CEq