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Death Certificate - Johnson, Cecil A_11/2/2005._._ ; � �Doo ��6 ��' LOCAI. CERTIFIED CITY-COUNTY DEPARTMEN7 OF HEALTH RECORD OF DEATH � Ciry of E�amville—Vmdeiburg6 Counq - � . Evam�iila, Iodinoa N° 3251 This is to Ccrtify, chat our rccords�show___________ �_ C�CIL A. JOHNSON .. . ----- .--------------------------------------�dicd -----NOV-----27' 1977 1:15 A.M St. Ma s '-a.�----"--'-------- a� ----------------�--�---'---'----'---'------' month �e�r hour o! de.iA �tr«q Eapitq o� m�l Agc at death_ 64--- Scx_ Male--- Color---�-------------MarYlEd---------------------------- � ><�n � ..rf4 �he[h�r memfed or dn�b Primary cause of dcath given �vas______ LllricJ failure - metastatic lung eareinoma . ----------------------------------'---------°------------- ----------------'-----------------------------------------------------------------°------------ S;�ned b A. M. Korn , Cit Y---------------------------------`---------------- Y ------------- wa.a. --------------- � , on>d��•" 2{}p{dp[ . Place of burial or removal___ �!1t.E Church Princeton, Irid. -----------------------------' ----------------------------------- � �.m. ar «m.un .aa�e.. ' D:�m of b,;, 11-30-77 Colvin Princeton, Ind. �_----- ----------� - ----------------------------------- --=--------- --FUnernl �Irecwr �ddr�u ' � ' ; i ; ; / . Signed ---- - ----------- ---- -- � d--------�.LL_Registrar. . .,' . .. ..,; ., Evarua il �, Indiana [sen�7 ------12— 5_ 77------- d.G 4z 230 � NOTE: Rccurdcd locally in I3oolc No. ______________ Page [Vo, ______________, ., FEE $2,00 • •