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Death Certificate - Seals, Clemont A_1/13/1983t �TIFIED COPY Of A DEATH RECQi. - — --- -- -----�— �-- �� .0. i�G4SIP�1ION a�, i� 514i[ OF ILUNOI• w�w��" � , CI�IfICi NO. J�l �l � . 4(�.�SII:FD � MED.ICAL CERTIFICATE OF DEATH " r:VUbl> �--•�-_' :��il�.!U-/:AMi ^•u .�oou .•�� SFI D�If Of O:�7M �•w...o...u�i ��•n'wt wc 1�'I310 ��OVC:fIt�L'Z' 21 � • a r..,. ,_ Clemont Ansel Sea]. s 7: . �, 1977 ., r.,�e.. �.Ct .-,�� .�c.o..•.•a•• � on.. �GF --� :.{1NpFi I YFAP_Slt�l�[P 1 pAY DAIF OF 61QIM 1 0.o-.0....<.n fUC[ OF DfAM co..�— _ .. - ' _ _ _' _ n.. .0 •'.n.l�'1Nf nc.u.�c.r.l u.�.m. ..�.L .oL : o.:� � . .�r� �'. • . I�ahite s,. "76 :sb. � is�. � ,�ec. 21 , 19�� ,a. l•;abash 'o-i.-ic.:. i... o� .o.o o�i�.{c� .-wd• ---- " s oi c�n '.minl� oi m.C. �.iinGi�...-N,�'--�o .oi �'ui.e:,-cLTii7u� .ro .u:�ui -- ' I.unol ' ,,;;p�y; ,e_ !+;t. Carmel :,�es '�a l4abash Ceneral Nospital __ ,._. E�:i�tPt�CF �u.+.o. �o..n. U11:fN Of WftAl COUNI¢T M�r�iED. tviV(¢ m�FPIED. NAME Of SUC:R'WG SPOUSE 1••�0.+,..i,n •..0 _"--'__ ___'_"___'_ .00.,..� _�_ WIDOwED QrvOVCED o.�u.n ___________ . F Indiana . o USA ,,, r„arried „, Verona Coker • _ _ ��.._ ��•�� - �o�L -:��;:?1� ;`- �L�r-z�a;L{�=_4°- — ou a or, / i .<.o,,.�.:, , ... `��7 �—� / — ._ . .. •,o_ : �_ , .. ... ^ '��.o�� ' oo'u�u�ii lz�:{�j� �'m� �` �_ _Z' _LL�iL%L�� 6 -__- �..0 �.�.. ..��. . Icl ilil il. OIH[f 51.'�NIfICANI IOIJDIIlONS: «^a^� �o^:•��w m �u:..v� �-m .e- w�e i.w cvu �n .ur i Ni I�VIU✓SY %� /' , I.u/.al -1/�/ i 19un� D!1! DI OPtP1(IION,IF AN1' �M1'.NOC fIND1'3GS O� OPFf!iION � ,b_ Retired ,.,, Indiana i,.b Gibson �nlnE:-l:AA/F n.v � .mou u Ed iI.FUCMANI'S SIGNAIUPE � v� � I �.:;v:%p ..� ie �,eii. DEAIM WAS CAUSFD BY, • O ��1 L�YfI 7 ' i,,,, Railroader N Seals Owensville ; hu/,ol ,,., No .no .w.i. RF'D 1 AWDEN NAMF ^'v .�omi - --- - i.v �dolli.e _ � Litherland NG ADDRESS I��nv ..o .o. o� �. r. o.. �n� o� �o... �i.u, nn � tVife RFD 1 Owensville,Ind: 47665 vo. ' Uc. (u�u wv OnE ouu n. u ro� 1.1. lel..•o 11 ' ••••o•�••�� • � • . ') ��u.u.wu�..00�.i. R .... . i -I1:::JtD InF O:CI•StD ft0'n, / u ilo'__'_'_" _� -...... 1 fl:lr?I!'1' TI(AT: Tl U.+ 111t AATE. M' THE S�::w�IViL � T.•a � � � % � �7:.0 � vH tu011971r) .i..� 'O .. . .n .. ..u: `o: ' � __-.710. /1��_!___'':9c_��Y ST iiP MY n.YJWI. :UCF. ' Nlg Of ATf/ �N:!'UKHG wNL PI.AI:l.'. ANG FHO/�1 THE CA NSt.'/�) SfA]'6U '_"'___ _____- '_'"_—" ' . _ _. . :D�IE AGP _-�t �� ,,.,., .,� .�..,. o. .. ,:-o. 1.1!3 ld. Srh St. i�it ".'Ca % .I �i 'ilu. � n� IF Al: IN)VQY W�5 WVOtVED IN iHIS iNE COQONFR mU17 8E NOfiF�ED. _ �+��.o�r..uq :ItbP101i IiCENSE Nt zc6sa ' .�. 1 Illinois 62363 ON,,� �CIME1tFYORI.C[tdAIORY-NAME ,IOUIIpN unn.iu«. s.o� :LUIi I.o+��.:....,•�•.1 9 � : : ial �a.,. D`aumee •a.� Owen. ��_�n �z.e. i o 9 �------------;- ------ svi e cL�_�—LL=23=_? ' NAME v.�u ..o .uoi. o .. o. -. un a� m.• �un � n. Holder Funeral Home 31`9 S. ��'ain Owensville Tndiana 4�665 ,:p� SIGy+AIUOE �� p� � �UNfUi DIIfC1OfS IIUNO6 liCWS( NUWEI /,.d� �`�--- - ---�_ _ .. C .->_ _ .� �._7294 I lllnob Dep�rtmanl 01 PuDllc Maaltb - Olflc� ot V Ibl R�wrO� '�aSED O�+ �wb U. 5. w i [/�C (+On�. On. �u�l �'�/%7i ;•� HfREBY CER7IFY THAT �b� lo�e9oinq i• o rrua tirt! �or�c[ copy o/iha deaeh ncord /or tbe d�cedvr� namad ol IHm 3, '� '.ondthor �hls nrnrd.rai.�ufablfahed md li(ed�•in..niy�offlc��•Jn accordmce wlrh tho p�ovfslom o/ rM lllirob srotW�r. .�-' , � . ' . \ i . � ! . DAT�_.—�ll�a�IZ �•I9� _- _� - . !AICNEn .R��.� � �.,/i..o.... ) � �.: V U `� � �.�. _ i�iL. CaPeiei � - ,;.Itlir.ois. -UFF?GAL TIT`� He_ �' ' �. "iA. rdrind r«urd ct tnl. dutIl b p�rm�n�ntb N�A v1�A tM ILW.VU!J DEPwNTM Pd � c«� .•�. a�'�'a'v. n{i•tr.n .n �+u�.�rla�d le mA� dNReaUon� Irom s�nMJet th� odfln�l ncord. Th. fll��l�lub DrmIJ� tb�t rh� nnt6c�C n ol • satA Dl IhMnm�ut of PuW�c RwIN or-t6� Ixal nQiN�r or W� aountl d�rk: W�U.li piNm�.l�ci� �rlMnn In �11 aourt� �nd ulaco of tW he4 tLerefn �ta[ed. , VS iG1A (�9L1 reviiion��` ��' BUR[AU OP SiATI5T.1C3.-�iLUN015 DEPApTMENT OF PUdLIC MEALTH - SPHINGF,IELO'