Death Certificate - Sives, Robert J_4/29/2003�
�o � — ooR�c�- c�o
VANDERBURGH COUNTY HEALTH DEPARTINENT 10224
Room 127 AdminisUation Building - Civic Center Canplex - One Ntxtinvest Martin Luther King Jr. Blvd.
Evdnsville, Indiana 47708-1828
CERTIFICATE OF DEATH
��ji8 �ertif ies, THAT ACCORDING TO THE R[CORDS OF THE HEAITH DEPARTM[NT
NAME ROBERT J. SIVES
o�EO�N VANDERBURGH COUNTY INDIANAON OCTOHF'.R 21 VEAR zoa�
TIMEOFDEATH 06:02 P.M. MARITALSTATUS MA�2RIED SEX MALE pGE 59 RACE WF{ITE
SOCIALSECURITY DATEOFBIRTH 12/07./1942
PLACE OF DEATH DEACONESS HOSPITAL
PRIMARV CAUSE OF DEATH GN[N WAS LUNG CANCER
rt{vsicinNOr+conoNer+ DANIEL HGNRY, M.D.
PLACE OF 6URIAL OR R[MOVAL NOLLY CROSS � F�P. BEUINCH � IN
FUN[RALHp�AE LAFIB-BASHAM MEMORIAL CHAPEL
C[I7TIFICATE NUMBER
OR VOLUME AND PAG[ '
nuroasv NO
MANNER NATURAL DISEASF.
DAl'EOFBURIAL '10/7..6/7002
OOOOZZZ�. DATEISSUED 11��4�Z��2
NOT VALID UNL[SS SIGNED 8 SLAL[D
/� �� �n � �n���'pp���� �
w'-Li �F�CL���D�Ct�T��N.
�__ ( M.o.
V�NDER011lVGH COUNiV IIEALiH OFPICLR
�