Death Certificate - Heacock, James R_10/11/1994� �
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� 06506 �
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( VANDERBURGN COUNTY HEALTH DEPARTMENT '
• Room 127 Administration Building - Civic Center Complex - One Northwest Martin Luther King Jr. Blvd. .
IEvansville, Indiana 47708-7828 �
• CERTIFICATE OF DEATH REGISTRATION •
���jis �ertif ies, THAT ACCORDING•TO THE RECOROS OF THE HEALTH DEPARTMENT I
I � I
INAME JAFff�S R. AEACOCk - i
• DIED IN VANDERBURGH COUNTY INDIANA ON sePTErisax zi YEAR 1994 •
iTIME OF DEATHO3:7O P.�S. MARITACS7ATUS K-�RIED SEX y-aLE qGE 69 RACEWxITE i
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SOCIAL SECURITY � DATE OF BIRTH 05�1411925 .
IPLACE OF DEATH S�I . M.'-�RY"' S•.'SEDICriL CE�TER ; '
. 1 •
fPRIMARY CAUSE OF DEATN GIVEN WAS HE.4RT DISEASE-DII,ATED CARDIOiSYOPATHY I
� 47fH LOGi C,IRDIAC OUTPUT SY�DRO`fE �
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• PHYSICIAN OR CORONER STESVART SMITH. `i.D. � � nuroasv�p •
IPtACE OF BURIAL OR REMOVAL�OVIGOPSERY � OAI�Za�I�D CITY.I��. MANNER j�t({TLR.AL DISEASE I
IFUNERAI HOME L�%�B_B�iSAriM KE'.K�RIaL (�`KaP�.'L �nre oF euaini09/z4/1994 I
• �
' CEFTIFICATE NUMBER .
� OR VOLUME AND PAGE 0000204o DATE ISSUED 10/06�1994 �
iNOT VALID UNLESS SIGNED 8 SEALED i
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