Death Certificate - Jackson, Ralph W_5/10/1993.• • •o������ ��������������������������r•
3128
VANDERBURGH COUNTY HEALTH DEPARTMENT
Room 127 Adminisfration Building - Civic Cenfer Complex - One Northwest Marfin Luther King Jr. Blvd.
Evansville, Indiana 4 7 708-7 828
CERTIFICATE OF DEATH REGISTRATION
��jia �ertiFies, T��AT ACCORDING TO THE RECORDS OF THE HEALThI DEPARTMENi
NAME RALPlI W. JACKSON
• DIED IN VANDERBURGH COUNTY INDIANA ON NOVEMDER 06 �EAR
TIME OF DEA7H 7� zG PM MARITAI STATU$ MACLiC.'CI SE% Male qGE 69 RACE
SOCIAL SECURITV DATE OF Blfiihl OC'PODL•'R LZ � LyY3
PLACE OF DEATH WELBORN }IOSPITAL
PRIMARY CAUSE OF DEAiH GIVEN WAS RGSPIRATORY CAILURE
IIRONCHOGENIC CARCINOMA OI' LUNG
PHYSICIAN OF CORONER KEVIN R. YOUNG, , M.D.
r�nce or- nunini. on nennovn� FAIRVIEW CEME'PERY, LINTON,IN
fUNER.4L NOME � COLVIN �UNERAL IfOME, PRINCE'fON,IN �J670
AUTOPSY NO
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1992 !
WhiCe'
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MANNER Netur�l Uisease
onre or ew�in� 11/10/1992
'• CEfiTIFICATE NUMBER �D��z173 11/17I92
� OR VOIUME AND PAGE � DATE ISSUED i
' .� - NOT VALID UNESS SIGNED 8$EAIED �
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VPNDERBURGII COUNTY NEr1L OfFlCER
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