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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 , ��� �
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_ S� ned b ' W F � Johnson - ' City - , , - :
gy -- ---- ---- -- -- --- -- - - ----- ---- : ^ .
� �-- phnieian'�}45i�Jitr, � — . - �;'- — � add�vj- i I — - � '
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'-=-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 .
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S�gned- -- - �^"�-� �iT ��y-`7 � - Registrar _ �1 " �_ "^ _ .
-Evansville� I - na • -. : -.:� 12 1 ,::- r:[ enc� �,�.
78 '
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_ . .• - . . _ , . '43 ;;, - �� �1�� - ii T�: •-
. NOTE:"Recorded•locally m Book No.---'- ----,Page No -_ --_ -- __ r_ ,_FEE•$2_00..:
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