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Death Certificate - Seib, Rose_11/4/1974���;. �. .� � '' LOCAL� CERTIFIED RECORD OF DEATH 0 CITY.-COUNTY. DEPARTMENT OP HEALTH ��� Ci�c of 13van.cille—\"�nde b h C �i �� � . . - r urg onnp � ... ' Ecan=eille, Indiana ! � {" � : . 5223 - - �p: e i�:. : P,;.� 7�his i; ro Certif��. that our records ;hur:-!----------------------------- '---------- died ^ ------------- �eb. 1^ �^%i. .-: ..P`, -,;e:b—,-n .-�r,"- _ . � _ , . � _ ., -----------------Jer-------- 1� � � -- __"_'_'_ _______'_'___________"__'____'__'__'_'"_' manth . hour of death ' --------"-- • -`�"r �� sveet. hnst�itnl or rurei .. •. . .. � �7 F=. �; , !�.,.,.;�:a A;e a, death------ Ses------- Color------------------- - -------------------`�� --.- >'eere ' vr�,� �.hciher"ninrried or eingle ------ . . � .��:i�CS�^ ,..i•]ai'o_:tl'�_ . _ r_ - �. Primarc c:�use of death ri�•en n-a;----------�- � �'' ° ___ _ i_�.�_' .1 C `.,n,'^.o+.,^, :� S � " '. . . . 1.!r..,OC-3:Cl'1r..._ ar r�ra.,... � . ...._.._" ' $ioned b�' __ J•_�1._ '`ll.�]�r..S . --- ---- '•',-: . . . . . . ---------.---------------".__.----- � . . , --------'_-_-------- . P rsic�en or cqmer ' . . ' . ... ' - '" addreee .. Place of burial or remo��al------ .=�• `:::'_::`__ ;-.� �;, - .� - � --------------'- -----------------_---- ' � . . . name of ceme:erv ' � - sddresa -- . .2-_ � n� •'. . :. . llate of burial ' ' "' �-� � _�-: --_.�..�er _- om ----------- ----- ---- --------------- �, --- --°---------------- ------------ . . ' uneral ADirecmr -- ' addr�s- Signed --------------�-� �(wr%fT/_�2tl�_L_![!^itcgirrar. ' . . . Evansville, Indiana =.-_ =-7? -__--____-- ' [`EAL) , � dace NOTE: Recorded locally in Book \a ---,-'� `�_ . . . --- P��_e \o. _=----------� FEE $1.00 a i-