Death Certificate - McGillem, Charles Jr_12/29/2000CJ
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�e VANDERBURGH COUPITY HEALTH DEPARTMENT �
Room 127 Adminisiration Building - Civic Center Complex - One Northwest Martin Lutlier King Jr. Blvd. !
� Evansville, Indiana 4 7 708-1828 I
�' CERTIFICATE OF DEATH REGISTRATION •
�his �ertif ies, THAT ACCORDING TO THE RLCORDS OF TME HEALTH DEPARTMENT I
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�� NAME CffARLGS MCCILLEM JR. ! ,�
DIED IN VANDERBURGH COUNTY INDIANA ON �ovennex oa �
� YEAR 199�� � ��
� TIME OF DLATH OZ: S% P,M. MARITAL STATUS MARRI�iU SE% MALE qGE G3 pq�E:'��{ITE ' �
� SOCIA� SECURITV DATE OF DIRTH ���1���1�31 f ��
0 PLACE OF DEATH DGACONESS IIOSPITAL '
• PRIMAHV CAUSE OF DEATH GN[N WAS ACUTL' PULMONARY EDI:Mn j,[;[�'(' {Q(�S POSSIj}j.r •
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�� .� M1'UCAkUTAL INPAItCTION NOT PROVEN I'
' PHYSICIAN OR CORONER ALLAN i'IARTY� M.U. AUTOPSY [�p !
PLACE OF BURIAL OR REMOVA� SOMFRVILLE CEMI:TERY. IN, MANNER
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FUNERAL HOME (;OLVT.TV ['U[VI:P/,L ❑IjM�:� I�IZINCL''�rC)iV�.Ii� ��]V]U DATE OF OURIAL1],�U$�1�)9/� I
CERTIFICATE NUMBER ' .
OR VOLUME AND PAGE 00002319 DATE ISSUED
].11ll/1994 i
NOT VALID UNLESS SIGNED 8 S[ALED �
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VRND[RBURGM COUNTV OFflGER I
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