Death Certificate - Stormont, Edward R_7/14/2004VANDERBURGH COUNTY HEALTH DEPARTMENT 04560
Evansville, Indiana
CERTIFICATE OF DEATH
��ji8 �ertif ies, THAT AGCO�DING TO THE RECORDS OF THE HEALTH DE?ARTMENT
�,,,F EDWARD R. STORMONT
DIEDIN VANDERBURGH COUNTY W�,,,o� .nmE io Y� aoo4
TIMEOF�EATH 01:29 P.M. �R�sTarus �RIED SEX �'E AGE 76 RACE �ITE
SOCWL SECURITY DATE OF BIRTH �-2�2��192�
PIACE OF DEAT4 ST. MARY' S MEDICAL CENTER
PRI.W�RY CAUSE OF DEAT}i GNEN 4WS hNLTI-ORGAN SYSTEM FAILURE �
SEPSIS
PHVSICIANORCARONER KURT BOTTLES� M.D. AUTOPSY YES
PLACE OF BURIA� OR REMWAL ARCHEP, CEMETERY, PRINCETON, IN �1NNER NATURAL DISEASE
FU�dcRALHOME COLVIN FUNERAL HOME, PRINCETON,IN DATEOfBURL4L 06/14/2004
CERTIFICATE NUNBEfl �
OR VOLUME ANO PAGE OOOOZZZS DATE ISSUED O6�ZH�ZOO�i
NOT V,�LID'JNLESS SIGNED 8 SEALED
� �i �/AUL/�� /� -,�� I.tD.
J.��v..zw,il
V�NDERBURGH GIX1NiY HEPLTH OFr"1GER