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Death Certificate - Simon, Harold C_4/24/1979_ .. _ . . .. ._ . . .. _ , . . .. , _ .., _ ,. __ ,. .. ._ . . . - . - � . . _ .' '. . =. . . !-- - - . . _. -. :� . �. . . =. �. . �. = . . _ . . . . . .�,•_� , LOCAL• CERTIFIED. �CITY-COUNTY'DEPARTMENT-_OF�HEALTH '� - �''(-- . •REC�RD-.�F �.DEI�TI'�� ' Qty�of Evau�ville=Vande�bucgh Couury- � �7 � -� C' �ry'e�' ' _� � _ .-- - . __ _ . . _ � Evaneville �Indiaui— _ � � -_lr�• �. U�/ 1;�'__, _ . . - _- _ _ _ � — _ . .c..' _ ' _' __.��'_ ' _ _ " _ _ _ __� '�••' This is to Certify, that our�recordsshow' _�'ROLD- CHRIST SIMON � ' !, d�ed =, . _. . . _ . _ ._ _ - --_--=_-cc-- _--- --, --- _,. . . . -.�.. =---NOV.-- -----24-------1978 ' 9 1SAM --_----------- ---Deacones� �----- ----- � - . - -----�at --------- � - - "" . ..mont6 ' •� del'�'. ' s�r �' - �.havr ofdeic6=-.' - _ - �treet:�htiDiul'm rvral� �� _ '" - 11- � — '. Agaatdeath----52-, Sex-----Ma� Color__�lte- -- '. � 'Nlarrsed = ' _ _ _ , -- 1ean. • - ' - "" _" " � viiu mhether m�rried or �in¢le '- ' - - �-.Primary caux of deach'given was__ Res�iratorx_ arrest _Bilat malignant �leural __ _�_ .. . , ._ ,. . _.,. - - --effusion=Metastatic �adenocarcinoma_ (gastr.ic.,pr.fmar.y)_�, i , �� •�.• i _ S� ned b ' W F � Johnson - ' City - , , - : gy -- ---- ---- -- -- --- -- - - ----- ---- : ^ . � �-- phnieian'�}45i�Jitr, � — . - �;'- — � add�vj- i I — - � ' " " ' . _ . . . . . _ . 'I. _ ' � . _' _ ' '�i.' _ ._ " '_ _ -.., -._- _ ". �_ ' , - . ._... .._ _ _ ' '-=-Place�of�burial or removai______ St; _Peter_&_Paul____ _ _ '__HaubsEadt� Ind____ r � . � . �• . - . . ' . . _ n�me.ot.eemete�'- - . _ _ . �ddr� . ' . _ _ '. . . � '. .. " . `�lt}�,�1. - f ; Dace of.bunal ll_27 78 __ _ Wade Funeral Home � Haubstadt1Ind;i !�, - - . . ' ' _ . - �neral Dimtor _ - . �. - � � —�ddrm _ "}� G . Y � � �,� � 1 '�_ xl � � /� _ .? S�gned- -- - �^"�-� �iT ��y-`7 � - Registrar _ �1 " �_ "^ _ . -Evansville� I - na • -. : -.:� 12 1 ,::- r:[ enc� �,�. 78 ' -: — - a,k ��. _ . .• - . . _ , . '43 ;;, - �� 1�� - ii T�: •- . NOTE:"Recorded•locally m Book No.---'- ----,Page No -_ --_ -- __ r_ ,_FEE•$2_00..: :: � � ._ - - �• — — - ' - -: �' _ - _ •:� •_ __ 1 �-"_ ! = = I' -_ c- � •-•�:.