Death Certificate - Smith, Ova W_11/18/1998i_..._.� .o.�.e.e .�._._.�.—•—•—•—•—•—•—•—._.
• 20816 �
VANDERBURGH COUNTY HEALTH DEPARTMENT f
I Room 127 Administration Building - Civic Center Complex - One Northwest Martin Luther King Jr. Blvd. .
Evansville, Indiana 47708-1828 I
�' CERTIFICATE OF DEATH REGISTRATION •
��ji8 �erti f ie8, THAT ACCORDING TO THE RECORDS OF THE MEAITH DEPARTMENT i
I
''� NAME OVA W, SPIITII i
o�eo �N VANDERBURGH COUNTY INDIANA ON Jn !
� • NUARY 14 YEAR 1994
\� TIME pF DEATH 11. (�O AM MARITAL STA1U$ ,�ari icd SE% Male AGE Bl RACE {�h1CC' I
ISOCIAL SECURITY DATE OF �IRTH SGPTGMIIBR OG , 1912 I
' PLAGE OF DEATH gT,�RY'S MEDICAL CENTER •
�• PRIMARY CAUSE OF DEATM GIVEN WA$ f
I Ilcart Disease- CARDIOGL•'NIC SHOCK f
j PfASSIVE STROKE
CORONARY A'PllEROSCL6ROSI5 �
i• PHYSICIAN OR COflONER LOUZS JANEIFJi� M.D. AUTOPSY NQ !
PLACE OF OURIAL OR REMOVAI ��LIiER CAMPCROUND CI:ME�PERY MANNER I
INatural Discase
FUNERAL HOME COLVIN FUNGRAL 1(OMG, FRINCETON,IN 47670
.� . DATE OF DURIA� Ol / 18 / 1994 .
i I
CERTIFICATE NUMBER
i �A �OIUME AND PAGE OOOOOOH� O1�zE����
DA7E ISSUED �
• NOT Vl,I.ID UNES$ SIGNED d SEALED I
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VANDEROURGM COUNTY HEA OFFICER I
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