Death Certificate - Johnson, Walter Carl_2/28/1975Y �\
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POSEY COUNTY BOARD OF HEAL•'fH
Mount Vernon, Indiana
CERTIFICATE OF DEATH
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This Certifies, that according to the records of the Posey Count}- Health Department
Name of Deceased :'� i `.� r ' ^ � �T�:t:1�2 _
Date of Death �a_nuar'�?_�. 19'07 �i co�cvci�le: Ir�d;�,7a
(Month) (Dey) (5'earj (gtrmt, hosP+�� o* rump � — � —
SF,Y COI.OR OR RAC£, tCA1tftIF,p. `:IiPC:g }i \IIRIt:D. AGF. �iv c..arsi I[ under 1 ve
\PIDON't:D. DIV(iRCFD (Specih.y :d0. llA7
aie wi�ite r�a_•rieci 7� 4
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Immediate cause of deatli _
Certified by F2u1 F -'c:ren, `.D, ?oeav�r_ile, Inoi2n3
(PF!YSIf,7AV OR'CORONF.R1 (ADDRESS)
Place of burial or removal !��ee Ceme�er-� _ Rt!r:al� �,J��nsville, Inr.iana _
(CEMfTERT) (ADDRE551
Date of burial J•r.nual;: 22. 19fi; Funeral Direc:or }{old�.� Funcral rio�r _
Record was filed Feh�u: r �-. _� ��7 Book No. =� Page No. 727 _
SEAL
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LOCAL HEAI.Tfi OFFICER, POSEY COUFTY
Issued On F°L�i•tL?.�j' js 19 ��