Death Certificate - Smith, Rita Ann_7/22/2004�����
JUL � 2 2004
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VANDERBURGH COUNTY HEALTH DEPARTMENT 01367
Evansville, Indiana
CERTIFICATE OF DEATH
��ji� �ertif ie8, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPARTMENT
NAME RITA A. SMITH
DIEDIN VANDERBURGH COUNTY INDIANAON 1�EP��'F.M}3ER 30 �EAR Z003
TIMEOFDEATH lO:�.O A.M. MARITALSTATUS �RRIHU SE% FEMALE qGE 62 RACE �ITE
SOCIAL SECURITV DATE OF BIRTH 07/30/1941
PLACE OF DEATH llE:ACONESS kIOSPITAL
PRIMARV CAUSE OF DEATH GIVEN WAS /INTFiACEREBRAL HEMORRHAGE
PHVSICIANORCORONER liAEiOLU CANNON, M.I).
PLACE OF BURIAL OR REMOVAL ST. JUSEPH, PRINCETON �.LN
FUNERALHOME CULVIN FUNGRAL HOME, PRINCETON,IN
CERTIFICATE NUMBER
O� VOLUME AND PAGE 00002.1'14
AUTOPSY NO
MANNER NATUI2AL DISF:ASE
DATEOFBURIAL f.O�Oi��OO�
DATEISSUED '10/07/2003
NOT VAIID UNLESS SIGNED & SEALED
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VANDERBURGH COUNTV NEALTM OFFICEH
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