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Death Certificate - Smith, Cleveland_12/2/1976� � ; � 1 �-- ;� : _ _:= � :� ;�: _ :�:=:.: := _-:", �._; ; -� _ `- r _ � � - -;; ,;::'s �� PERRY COUNTY HEALTH��DEPARTMENT. � --.-::---� � — — ; :_ — •-- -�— _ . .. . - , . — - - � � � � � y ' canne,lion, tnalana : � . , , `- , . . ; i , - � i' � BECORD OF DEATH • ' , - , , ,. , , _ � - .. :; ' � ' .....;.... � ,_ �� - -- � { . _ .,,.... � ., � _ :_ , . . ' , _ I:•-_,i -_ :s-:_ ::__ � . � _ � .: �. :ii,._::i' ._:�� :. t_. ! 7?..— .� � _ `• ' ' �i:.::�i::_•:. s" -Ttris-is to,Certif ,that our records show' �tans on�.Cleveland ��n th - - �- �. . : .,.___ _._.,.---'` ' -- - � .� ..:,.....• . ... .,.::Y- - _ � , �;•- - - . -- -==:1: -- ?' - � _ ... ,, _. ' 'i � �' .: ...,_ _'�-, :: , .;, _. . _.� .,, , . . ,. .:: .. , --' ' ';' _ � '� � 'Taniiary � "" t_5 � = �194?_ �gt� Home-near �Canr.elton,•Indiar.a .�' +"-_ _ j 't�-;':mon[L . -- "-a►:_�- -f 9uc' - --'it ;�- :i._'.Dlata.otWaO. - - - .. _ 5 :�. .,: ., .�.. . � . ' ' ' ' . � .. _'<�'_' ;. e �Age at death 'S� "Sea� male �� w.tiite ��ariied ., .- ._._r• _ —, _ ' � ; - -�. � -: aa.s � � . - ' : ' i �� = i , �� . _: � ; . -_ .. . : ..Nee .new.. m.=:aw, e.. ma. - - - '� ' �� Acute �lyocaidial Infarction ' ,_ :Pnmary.cause of.death given was � � - ' S, :' � � , � t; ! , �. � _ :.� ;`. ; ; � � � �` '__ � .': _- - . . � -{- t , � t � :E.;' !.' � -� '�-- '.�- . �S . - � , ::_' i `.: .� ' - ` . •_� ' �,, -:. � Signea ny Ivo=.N�ber, Coroner :CannelSon In�iana. _ . �a '' - . � . , � 1. cw.m.o e: �a _ _ - _ .em+. ' - Place:of bunal or removal St".—�ltchaet's -.CecneE�ery�� Carnelton,�� '-' `' : t , , i , . � � o,m:,o� «m:r.s i _ � j .eeR+ �' . — �:. � + ...Date of��r�a1�1�:Jan,iary �1?; 194Z ��uuber Funera�l No��e� - "•'- I - � _' : 1 r . � `r ' � mreetm ' . . 1 � 'aar'sr ' ;. � . -'. ' . � — � i Q�� .,._ ' i � — 1 - -- . , f - .'� '�' i' � ' I.'`,��Z .,'�� -�•6`!C'd _ :� .'.� ' ..H��}1-��1('.�Z i> _ ` +.. . . .,i -. . _; .. .. \ � _� �]�� .-.'1 � .��/li (t �:: r( S � ' '~' '";z ,t P7�"�/:ZYl�`-: � _ _ i. -, �, - + �!+- � ;, .; Cari It � , Indi6na� _ - ,. . , . � �;. � � -_' , - . , �(SEAI,) _, '� _ : .: _:: i �. _ _ � - � : � �NOTE Recorded'Iocally m Book 10' `� Page�M � CertiGcate Number.24 _� � , � �" j t�-- , �t .� , - _ -� ' � �� - :- = ' _- '- i = '1 . .� fT � � 1� .i � ( �. t � :. e 'J. �� t. . � � _,( �- , ;, � _ _ �� _:, i ,�,,;. �� _ . „__.JI.L ..�..�.�---� _.-::-" -- - -.. � --. .. � ' -- .. ..-.. ..�� ...�..... t.. , �