Death Certificate - Nottingham, Dellas R_4/14/2010�i
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POSEY COUNTY BO.�RD OF FiEALTH
Mount Vernon, Indi�a
CERTffICATE OF DEATH
This Certifies, that acco.-ding to the records of the Posey County iiealth Depaztment
I�Taaie of Deceased
Del=2s 3. ?�iot �
Date of Deaih T�ece-ber 18, 1°SO
tMonw> cn.$) tr.,r>
�EX COIAR OR RACE :QTRRIED, tiE\'ER M4ARIED.
� WID0�5'ED, DR'ORCED (Specify)
a_i e ldC1 �E ��T'_eQ
at p.?. 2, Posey-�ille, Lndia-�a
�s:�; m.��ti � .w�
AGE (iv .e:r9
�2
Immediate cause of death '��-=�c �""-''-'•:; �'-'-`"-=z /
Certifiedby 1'e�^; o SOi:1i,}1 !'1.D. P052V'4'112. l.^d_2ny
(PSYSiCIA.\ OR COSONER) (ADDHF�B)
Place of burial orremoval Yose.r�-'-11e C2�ete�- ?ose�,nri�le, Lc_c.^2
(C�M��Y) --(ADDRF_S9)
Date of burial D�ce-�bar 21, 1°c0 4ie�zv �.era� �o �e
Funeral DireMor
Record was ffied �=ce� ber 2G, loap Book No. °-'i-5 P.age No.
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SE.�L � t���,.��, �
Issuzd on "�r=� ��� .19
Form DPC
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IACAL
POSEY" COL'`1'17
REGi57RAR OF VITyL RECqS2D5