Death Certificate - Smith, Roscoe Eugene_8/21/1998�
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VANDERBURGH COUNTY HEALTH DEPARTMENT 14205
Room 127 AdminisVation Building - Civic Center Complex - One Northwest Martin Lufher King Jr. Blvd.
Evansvil/e, Indiana 4 7 708-1 828
CERTIFICATE OF DEATH REGISTRATION
��jis �ertif ies, THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPAR7MENT
NAME ROSCOE EUGENE SMITH
DIEDIN VANDERBURGH COUNTY INDIANAON AUGUST 13
TIME OF DEATH O4: 4E A. M. MARITAL STATUS �RIED sex �LE AGE 7z
SOCIAL SECURITV DATE OF BIRTH 03/04/1926
r��nce oF oenTr� WELBORN BAPTIST HOSPITAL
PRIMAHV CAUSE OF DEATH GIVEN WAS CANCER—BRONCHOGENIC CARCINOMA
PHVSICIAN OR CORONER JEFFREY SELBY, M. D.
PLACE OF BURIAL OR'REMOVAL DECKER CEMETERY, PATOKA, IN
FUNERALHOME COLVIN FUNERAL HOME, PRINCETON,IN
CERTIFICATE NUMBER
Ofi VOLUME AND PAGE� 0000163r�
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AUTOPSY NO
VEAR 1998
ance WHITE
MANNER NATURAL DISEASE
DATE OF �URIAL �8�],%�],998
DATEISSU[D 08/21/1998
NOT VALID UNLESS SIGNED 8 SFALED
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--VANDGRf1URGH COUNiV HEA�`OI OPFICER