Death Certificate - Johnson, Victor Karl_2/4/1999�
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VANDERBURGH COUNTY HEALTH DEPARTMENT 11039
Room 127 Administra[ion Building - Civic Centei Complex - One NoRhwest Martin Luthei King Jr. Blvd.
Evansville, Indiana 4770B-1828
CERTIFICATE OF DEATH REGISTRATION
��ji8 �ertif ies, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPARTMEM
Nnr�E VICTOR KARL JOHNSON
DIEDIN VANDERBURGH COUNTY INDIANAON MAY 31
TIME OF DEATH � O: ZO A. M
SOCIAL SECURITY
r�,R 1998
MARITAL STATUS wIDOI1IER SEX�LE .AGE 80 w,c�HITE
PL4CE OF DEATH ST. MARY'S MEDICAC CENTER
DATEOFBIRiH ��122/�9��
PRIMARV CAUSE OF DEATH GIVEN WAS RENAL FAI LURE
SMALL CELL LUNG CANCER
PHVSicirw oa coaoNea RICK J. BALLOU, M. D.
PLACE OF BURIAI OR REMOVAL l�{j', OLIVE CEM. �MT.OLYMPUS. IN
FUNEFALHOME COLVIN FUNERAL HOME, PRINCETUN, IN
CERTIFICATE NUMBER
OR VOLUME AND PAGE OOOO � � SS
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ti+nr+NER NATUR,4L DISEASE
DATE OF BURIALQ(��Q3� � 99$
DATE ISSUED 06��8� 1 9(�8
NOT VALID UNLESS SIGNED & SEALED
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VANDERBVRGH CWNiY H TH OFFICEfl
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