Death Certificate - Skelton, Jack W_3/31/2000_ o�.9-Gac.a�-�
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VANDERBURGN COUNTY:HEALTH DEPARTMENT � � 270�
Room 127 Administration Building - Civic Center Complex • One 1Vorihwest MaRin Luther King Jr. Blvd.
Evansville, Indiana 47708-1828 - -
CERTIFICATE .OF DEATH REGISTRATION
��ji8 �ertif ies, THAT ACCOROING TO THE RECORDS OF THE HEALTH DEPARTMENT
Na,nE JACK W. SKELTON
DIEDIN VANDERBURGH COUNTY INDIANAON
TIME OF DEATH O2: LS P. M. MAAITAL STATUS �RIED
SOCIAL SECURIN
PLACE OF DEATH DEACONESS HOSPITAL
PRIMARY CAUSE OF DEATH GIVEN WAS P��MONIA
PHYSICIAN OR CORONER JOHN LIMING, M. D.
J1JNE 30 , -
SEX �+E AGE 6$
DATE OF BIRTH �8��1�1929
PLACE OF BURIAL OR REMOVAL I.0.0. F. , PRINCETON� IN
FUNERAL HOME � COLVIN FUNERAL HOME, PRINCETON, IN
CERTIFICATE NUMBER
OR VOLUME AND PAGE OOOOS.�L%Z
YEAR 1998
rucE WHITE
AUTOPSY NO
MANNER NATURAL-DISEASE
�- - DATE OF BURIAL Q%�03�1 J98
DATE ISSUED 07/20/1998
-� NOT VALID UNLESS SIGNED 8 SEALED
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