Death Certificate - Shannon, Carlyle_4/7/2010i
VANDERBURGH COUNTY HEALTR DEPARTMENT 3 4 711
Evansville, Indiana
CERTIFICATE OF DEATH
�his �ertif ies, THAT ACCORDING TO THF RFCf1Rf)S f1F THF HFGI TH f1FGGRTIAFNT
Nnr�E ��P.LI'LE SFiAivNOtv
DIEDIN VANDERBURGH COUNTY INDIANAON
TIME OF DEATH 1�' �� �•=�� • MAHITAL STATUS �tARRI ED
SOCIAL SECURITY �
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SEX AL4LE AGE 79
DATE OF BIRTH 02/23/ 1930
PucEOFOEnni DE.ACONBSS HOSPICE C.�RE CE1�'I'ER
PRIMARYCAUSEOFDFAiH�GNENWAS �SPIRATORY FAILURE
- _ - ACUPE CEREBROVASCUL:IR ACCIDENT
'} ' �`�•�� ARTERIOSCLEROTIC C.ARDIO.aSCLZ.AR DISEASE
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PHYSICIAN♦ORCARONER � DOUGLAS' H.ATLEF� �i.D. AUTOPSY IVO
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YEAR �009
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PLACE OF'BURIAL OR flEMOVAL ARCHER CEMETERY MANNER IVt4TUPAI, DI SHASE
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FUNERALHOME".��COL�'I'Nr�FL!\iEAL HOh1E, PRIfiCETON,IN DATEOFBURIAL O/�11�3009
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CERTIFICATE NUMBER
ORVOWMEANDPAGE 0000130% DATEISSUED O/�1���009
NOT VALID� SI�E & EAL � �
M.D.
� VANDERBURGH COUNTY HFALTH OFFICER