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Death Certificate - Lamey, Victor_2/7/1977aFronn or nF � i Fi�� .�. _ . �°�' - ! � �, / ` - - �C �' O�' k �TftNTi DF.PAP.TIIF,NT OF P3I:9I TI;'_ ' � � / . . � , :rr r��r.ro� i�.maN � �_. ' ;. � _ � . .�; � . '� �- �� �`. yTfi1S-1$TO CERTIFY, tliat om• rcco Is sho�.---- --- ROSF' K._ LA�T�'Y t- Z�--- ----- ----_dicd ' -. _._December —3--- -- 1-g'?_���--��� i .�M:—FIaubstad.t.,-I.nd. , monih— — dac yenr hoi Ic�ith slrcet, hospital, nu:J�_ Age at Death_�5 __Se�_ re?nale_Color k'hite i?aTried Y�a�� �crite �chedier married or single Primarp c�use of death given was- -_Met3static-Me1aXlom.�t __ _ Signecl bp_ _____Aobert A_._Royster_� F?D Ev�ns��ille, Ynd _ __ physician or coroner ad<6•ess -___ r Place of �ur•ial oc i•enio��al_-�t_,_,7ar�gS_ C.2mB��T�_____HauttStH$�: Tncl,— _ -� -� - — name �uC cemr.tery - � sddress - ' Pate of hurial__ 12��1.7_Q-- - Idade_FunerALHome_ —F3auhstad.i.Y_ITad Puncral Directnr ���{ �s � � � �._ , SPAI. Signed_�;�'t�;�,�;,�j��,P��O . Cibsa� Coiuity I ealth Commissioner — � - — _ . _ ^,� . Princeton, ind. _ 12�1']/70 � address - . Date3--- �'�. . �i l:ecazded locall�� in bool: No. -f!'Jl ---Pn�re No.��- I'iled` '- �p '� - - - . �."'""'.'_- _ .-t.r-_�_�"--`_.,'.r- ' � -- � - - --� _��'- � • - ----J¢� iP�l� {�i�AI.Yi-i A�t� WOSPITAL G�RPORAi90PJ OP i�iAftl�f�! ��UfilYY DIVISIOfV OF PIJDLIC HEALYI-1 FEETWODQLLARS — 1847 CITY-COUNTV BUILDING - IMnIANApOLIS.IN�. :�uvmcn nnoro.rwm n�oc �^' :�EFtYII'I�D e.^,Of�Y O� RE�ORp OF F�EAY�� �9FT � Victor La�ey , NANE OF DEGEASE� ^ATE OR DHATN Febe 3D 1977 'PLACH OF DEATH, COUMT.' MARION QTY, TOWN. OR 1.0(:ATION Indianapolis�3ndiana n one•.n � ra. v eecm u na> m81C winowea � e�evcn nAna. ❑ 1p5=1901 „�E 76 I voa. I oaro I nr.a I cm. S�r `Iann�¢D ❑ olvonCCa QDATG OF AIRTM FATHER'S NAMF PCY.Bi L8111EY ��OYIIER'S 1.1AIOEN NAMF VeI0171C CAUSE OF DF.ATH PARTI. IMNEDIATECAUSEIAI Cardiopulmonary arrest � hyootension e co�c�noHa. �v AflY� Ventral se tal defect WN¢q arve r�ou io DUE. ro �91 P apOV¢ GU9C (NI 'OTNTI�;O TnE YNOFJ:. lrina c�use uar. DUE TO cc� Acute myocardial infaretion urtcrtvn� oerwcen OTM[R GIOMIFIGANT CONDITIOMS CONTIIIOUTIqG TO OC4M pUT IIOT RELATCO TO TMC TCPtl�N�L DIBCASG CONDITIOfI 61VLN IN �ART 1(p) \ �9HT II \ � � ' OF DURIAL 2.�e%% CEMETERY_ St.,Yame„ cers7. NO. OR =- -�OL AND PAG� _DEATH GER7IFIED OATG FILE� � 2�7�77 onn ic3ucn 2°�°�� • H,Chadr7it.: CLGRIC .,� �'�C:::�tK�,. . ' �}�� � 1 1. .� .. � � �� . j � ��� . . . '" _- . � . Haubstzdt,ind David Lee Wa113ce,H,D, (�lOY VALtn lJN1.ESS MACMIN� fy11A16F.R�D i AN� SIGt�lP� tZ/IYH MIJLYt^QI,QR RID6LIN � --- . . ' .� l..- ,�-,--._�...( � - �' ^o.. `;"`\ �^i' +`, :� . ' _ i :- . .. . $ . I� . ( ' ! �'T �[ ( ? t- b. -. -;.� '.f . . . " . .-� c_ . . . � - � ' •! , Y f. .. - r�� _'' � �� �