Death Certificate - Gross, Carrol W_3/3/2003- -- ------ -..... _ - _ - -� -
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VANDERBURGH COUIdTY HEALTH DEPARTMENT 04463
Room 127 Administration Building - Civic CerKer Complex - One Nathwest Martin Luther King Jr. Blvd.
Evaruville, lndiana 47708-1828
CERTIFICATE OF DEATH
��jis �e rtif iee, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPARTMENT
�N� CARROL W. GROSS
DIEDIN VANDERBURGH COUNTY wa,�,oN Jut�tE 1$
rwEOFOearH 02:22 A.M. MARRIED MALE
�4LIRITAL STATUS SEX
SOCIAL SECURITY
DATE OF BIRTH
PL4CEOFDEATH DEACONESS HOSPITAL
PRIMARY CAUSE OF DEATH GNEN WAS CORONER-RESPIRATORY FAILURE
TII�ORAL LOBE HEMORRHAGE
SUBDURAL HF,MATOMA FALL
PHYSICUW OR CORONER �NALD ERK, CORONER
PLACE OF BURIAL OR REVOVAL DURHAM CEMETERY, FT. BRANCH, IN
fUNERALHO:A[ STODGHILL FUNERAL HOME, FT. BRANCH,IN
CERTIFICATE NUh1P.ER
v� 2002
AGE 61 Ry,cE �ITE
11/08/1940
AUTOPSY NO
MANNER ACCIDINTAL
DATE OF BURWL 06/20/2002
ORVOLUNEPNDPAGE 00001321 DATEISSUED O%�OS�ZOOZ
NOT VAL1D UNLESS SIGNED 8 SEALED
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VANDER&1RGH CIX1MY HEPLT OFF10Eq
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