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Death Certificate - Kruse, Harold_10/23/1989�.�.�u<�. =' _'.•_: h � _ � �/ / 1. � 1��. y., 4..� '�; � W's. �.�--� ---� n ��. � �r{ : I^' NA STATE BOARD OF. HEALTH �,�.t s ; .ocal No . .............. �.�.�. � � CERTIFICATE OF DEATH �State No. .... . ............................ � NT �' DECFASED-na� FlRST �oo� usr � Harold� Kruse 3. SEX 1 DaiE Of DEAiM ac a ni Male 3-12-89 . �`"•"° 64 �• o•r� �• M�•• �"=ib-24 � Wn�rick Co: Indiana ' i B.YEAfllASTSERVEDW 9+.PLACEOFDEATN(G�ct pwSe�nab ��1 ' � US-ARtI-OFOflCES) rypSWiAL ' Y. OiHF0. � � � ❑ Np�oeiu t`J EX/OV.w�ara ❑ DOA I— ❑ NvupMOm� O Hr�Nmc� ❑ ON�rfSprc/yl SLfACl1:YNN.4(tc.iuc �e� :w:.::_`..—.: 9cC!!Y.TO::::.CP.ICCAT:DNOFCE>T11 .'i1CJV'>:TYOfDE?�n Welborn Hospital Evansville, Vanderburgh 10. �nnPoi<L SiA:US—�.4rri�e 11. SUBVNWG SPOUSE 13� �ECEDFNiS USUnL OCLUa1T�0e� IIp KWO OF BVSWE55/wWSTM rv..e, �+v.+a mea..a �u'.,�. a�. m.iOm wn.) <G+�. a.a ot wk eav e:�m mou d�u'�M ui �"°"f�i`�f��ied Clevia Enlow °°'"`""""'°' Retired Amax Coal Co. IAHESIDEI:CE—Si]iE IJ>COUNTY IkGiV.TOWN.OHIOCAiION IMSTFEETANDMIM9EP Indiana Warrick Elberfeld, IN Rt. 1 Box 13 Uc WSIOEpiY IF: iP0.N 1]� ZWCODE N. WASDECEDENTOFHISVAMCOWGWt IS-MCE—AmrK�nYqun 1l.OECEDfNTSEWCATION lWJiS)<rnnml <SMC/r�'oaV��.Yy�a�, lyCWwt Bxk�'�M�.n[. ( F M�rvroMM Mrac�n PUmo iYC�n rtU xl No ❑ Yu ISnc/Yl ��m� mOny 10.I tI GW p� U.� w S� 1 NO YES 47613 �'r White "�� 1). F�iHLTS NA1.1E IFiR Mdde. (�ttl 11 MOTI�HS N>ME � K M49�. Mrl�n S✓trrvl r, 19a. WFO:wnHi'S NauE (Type/AiM Clevia Kruse 2G. I+£iY.OD OF DIS?OSIiIOV ❑ Bv�4 ❑ G�m�mn ❑ Pe�+. � h � Su ❑ Don+uen ❑ ONrrlSO.cly1 !S ' 3��. SIGtin:UPE OF NAEML DIHELTOT :/_ • ., ^ �'� co�a.�..n,� .<a+,. .n.n cenlyxp , r��n b nd �w4?'� �t m� N ouN m amer u�,.. a e..m x<. TwE OF DEntn 12i42? x.t. Tom.e•n $ipviv�W fd� < ti D4TEV0.0NOUn Nora Seebode I9Rt 1pBox 13 lE berfeld, IN�4�613 � �W'ife i00- ORiE ANO GIACE OF DISPOSITION Wum d cmvtvy. c�wwvey. r 20c. LOC>TION—Cry > im�n Su�� oN✓ We�l Nobles Chapel Cemete y Elberfeld, IN 3i6 110El15E NUNBEN II NAME ADOPE55. AND LICENSE NUMBEfl OF FUMNAI M0�4 �a4��� Simpson-Vollanan F.H. FDH300167 �J-Y-� FDE1005141 Elberfald, IN 47613 pe. CaN wcx�W rt 4 �. � d�u �mM ]�0. LICENSE NUM °�� /�. ik OPTE 5 D Iil/�, %/ ���'��'' alo�' �f `"sil�d� }), pPflS L Fne� N� CiSY��R nNiei Of [MO�UINOt OY� GY�ltl N! pY4t DO IM �M� vreK Vckp�vuil�!>�.LUimFyam f�m��c1iM� . )q IMMEDIATE CAUSE IFYVI /�/ E�suu a caqaKK� �. r��WV+pneeaW "ET9.� O(OHyS�CONSEp �CE � �ji � iwuT �%(� /�t Sttuem�y�ncoMmna. n. d any.4w.q w m�mru /J DUE TO IOfl n5 A CONSEOUErvCE u�r.ErserUrNfXVwG e�/i2�� i- n l.i ��' CAUSE fan�a. x M.+�Y (A�v—/ Nm m�<a �+ena DUE i0 WP AS P ONSEQUENCE rss:l�+p n euuU USi 36. WAS �FEWiED TO MEDKnI EUMwEq/COPOrvFA> .. e rot RCE� W EY`9� �eGl�'CIIG4C IX![�Ga��dY . ; e fGr�c/� . G-C. � I- 6 PLRi LL Ol�er fqMia J corb�lron� COtYi-adq �0 OeM Oel rvi. n� Wup m N� wqMyiip OW � Onm O VaM1 I. 38� WA$ AN AUTOFSY FEHFOP t lYn . �W t9e.CEniIiIEA �EflTiF GFHYSICIAN(Cl�yfK4ntNp'�pUUf�OI�NMwMn�mNnMYK4rvNlpmd/CIEEVNmECMYYet10RantA (C�e[Y Wy �� TO Mf� OI my FINM�OQe.OUN pC[MV0 tlu� la N� [wtN�) YE 41YY�V u tLllQ PHONOUNCWG AND CEflTIFYWG GMYSICIPN (PhyvrLn DoN pvrwienp Oe�M �M crdy�q c�wW dwW Ta N� W p 4 nY Yro.A�W�. erN xcurtee n N� om�.0�la W Wc�. W N� �o N� u�t�41 W mwvr �� MM 38> SIGVAtUiS JO Nan�E AND nD6PF55 O'r PERSON NMO Kevin Youn� Jt. MEALTM OFFlCEAS SIGNATUFE . ..�.::... ]SMnNNEAOFDEPiH' �j ❑ Na:atl �JV�nA�'q ❑ AcaC�R ���� ❑ 5'Mr.� ❑ CoNO nm Dr u— H�x D�trtmLxO M.H. ' � •'� >OYa�mn� t�mN B�Mem �,..,.,�o.._, 1.�-J�?!'� ]!p WEIgPUiOPSYfWOWliS avaRA9tF PPoOH t0 CO�ET�ON OF CnUSE OF pEPTHi IY�a e rol MEFLTM OFFIGQi mv owwn a.wi accvr.e n ilv wv. au ua Wca .na aw m M uu.�t.t .N �wr�w u mi�a. 29c IICFNSE NUMBEP ^ ]9M1 n/;1 3a�% ! , ii Evansville, IN 47 : :> - , E .. . N�- DnTE OF V31URT No. TIM O� ( J�c WNRV �T WORK) (MaWWr.v��rl WNY tY�.nrol ]2 OAT[ f�Fb (lbeh OB��rI PJUI � ]��.PLPGEOFWNHY—AtMm�.I�r��v��thttory.oHk� I NI.LOCATIONISbM�MMmiDwafM��NO���NUnOx.Gyxio�:t5�ns� �utlUM. na ISO�Y� . SBMO6-00� Sta2e Form 10110 (q/10-87) o��"��