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Death Certificate - Wallace, Verma_7/11/1966� J ,Ir_� I` .�. �;� I�.F-- �If=���' If .�I 4—�� ��'�� .3� i�-�-� l�� ii�--�'Ir_ �. �— I _ . _.C. n� I �. -� � T I-i�. --' ' r7 i,�-1� � I� .. -,il� � yi.��'I� r—���� _ �''r�"`_' ..;. �I I_` r� i:'-a h �u I -�.i��Cl!�� i- � -J' � ���d�- L �_.:i�- r i , .� � •`1- r�� � �-.� �� � _ 1t T� _ � � rr+�������r��r��i.- ��,� �iilr-ill �r1I�~�.1 . 711�r- i �li-yir�-11 . � � -1� �i'r ��, �- �: r' I' �1�tLOCAL CERTIFIED����� �CITjY COUNTY�DEPARTMENT-0F H�EI►L`TH��,,�� `J �l_� `_ v� J i� :'; •_ , RECORD�OF DEATH_� i�=�,r C�ry�of'Evamv�lle=� Vanderburg6 Cou�tyi r - _ �i L - .�I '�'�1 I L �'� �Evaniville Ind�sua�r �� I�i� � �.: � . - , , T, � , � � ����^� N 19439 � � ��- ,��� L=�i J �L" I J i i i �I �I i�. - i Ir� . ��; �� "` -_ `�--L—��1L'��..1F��_�.a— � �-l=�llli._,. ��L�u.!_���1.��=--� 1 .r—'9 � � 1 f"L �_ 'tr - r—, i . . _ .: 1 �. r n . �-.� ..�f�l i.-� � �T� �l��i� �Ir i�,- i,� --� r� � ' I�_�i�lll. _ � �-- �� � i' FTh��s ,s to Cernfy,:tha[ oui�I�rds�show �_II �_i_F'+1zi8�W811RCe r _ r'I_;-�i �_f �_ti �T�lilll dted ' ���� ��L _��1G'J� _ _LJL__�..r_JL=�11�Ji_=-i.1�J'�_�..1==i1==�.'�1�=.�W�.`=z:.L_.�L=�._� - —� _ � 'r.`,��i Ftieb:`-i,i�f-' � 4 ;!� r 1960 1, �.a`-8 50 A':ti ,;;i ,_ ,IiEv n pi1Te_ State 3ospital ,`�— i � 1 � I �=�^i � mantL �� � � - dnj —' � � c.i� � . ._' ' � - � _ � � � i �CxM. 6niDtti! or me�l �i � � �'_ ' ~ — 1� �L=� _..�Li�_=.ulC'J�� w:=.,inunc�.f,..°°!L._=-1��.�� — t,..�� u _ �__. �__..,i.t—� — i" � lll�r � i(���tj'68 i I, _� 'tia:��r,.' -l� irh: c-� '' , i�c '- �k�iaoered r, �ir;, , i� � - �, Age at death _ _ Sex Golor�_ __ ,_ _ _ ____ � L �.; _ Ji1 .�_±i�1�_._ ���iF--�1?sn=1t���i.._�_�_ �� _^'��JJL--~��=J�l�= wrlte:whetLa�m�rridor,+��.`- ��_.'.�- � ' r n' - l: ��";---I�r.�, _�, : - . =r _� . �� - �, ----� ��} ��� f � � ll � - �� -',. � �-„-• � I� � r�I��' 1'BSOIIC}10PT10UII0�2.. �Bilateral� �r'I'IR��. � ..f'_� _-_ - "I�LEr�mary cause of death given�RU� -- - � ,� _(r—?�=��Wt_i.= _.�.II=�� ��1�_ _`�1:'—.—L.,_.�,��_ . �- � r1I�Jl �� r_ �l�c_r_. . i li r ��. _ iir�i�c. I -�,--� ��rt llr _�_�� _!- �ilc 11 . i. '__ y1���L ����=,j �i T `�1-'..� � L= ��� =�4�;�L__ ���'��.LL , 11 ��i��-���i � � r _��F1 � �L_a I_'.I�C.1 il�l, ,�__ t_ -_F � Siechle�G- - r- r- .-_ � r=-r-iF�l� r-_ � ��-� �- '-Signed byc �+� �"tL31i.� V� �itwt� fi�-nhi:irl.n m �3�8.�_a._�rti..(i I�it,.t'�"'�iII I jT `Tij�`I�"��.}�" �TClf�:Wdres T'�'�t''L �'-.�;�""'�Yi "*" �� ,,`.�1 _���=�:� , � ���J ��� L t��? =-L = ��-- -�-� � - '!- �� ; Place of bu`nal,or removal1' �barty -�� tr--, _,i.- TCynthiana� Znd. H1L � �_ _ i 1 �iLl li L ' i i i I i•iu� �I i i � -� �� H-� i .i � .. . . - i � � ��� L_ �`� � �ama of o�etc� i �L L�1.1 � �' ed�s I�''' �j I-1�t I - �I�ILJ l� _i �J. � = � �l�'� I�I'.� �.��IIiL ��C-' �41�_i��-�=�C�'_J�.` .i_ Y�. _ Wt_'I _ ._ � 'i.t�.� ��_�_ _ . i�___ . - `- D c af eu���6=60-� r-T"�Bialer-Werr� _ i� �;1�'i �'Cynihtanai Ind.=�lt �"iF _-��i - , � tr.1 � �� � �y. , � L� �J � ' ' -�-- � = t �I I-�I I � I~--- , I�-1. i� rae� $i�w. �i a fl i ���`�'il� J � .am� � r =�.u.: %J /� r-g I/f �y s._ �i tk_�L +1��1'= � i _ F- � gned i��� �� ,/l� I'�fZC'TiIY/h'1�KC /,I ��Regutiar � ���'�-� � � � ��1� 1�1�-ii' . -- ---- �1��� ' - ��..r� I��...F.'�`l �'�'�- �li`�ul. ������.1C. L-jL'�I�LtL i1-�� � l�i��j1 -' I� � I� 1" ,It i�ll� .�K �_Evansv�lle, Indiana —, ,.=,;,��-,-, �— 8-6-65 1I ,- _ tsEaL�- _ � �� '��.L`= ir . 'L�7:�-�� IiJ i l�i il��� .� ��i�� � Jtr Ji I '�.l:��iI`date .-�t�' �Rrl 1 �t 4 �4� . ��i�� �I �� j Ir . C y— . � _, �,—, � ��lii ,l,_ � ��I ���� ��I� ,l,�J ���-��_�L,. —_ � = i� �\OTE Retoirded-locaIlyi tn Book No �_- Fi.,.l�_-Page=Nb 2J�. _--•�i� i„_T c .�i "- ��I, ',.i.i.-., .�.'1Tll�. �'Y.I.. T.�I � i�'^ I.� __ ' i.�'f���f�' 1 '������"^l���l�fiitll' .11'I.-� �Y t� � - L• � �+:lll ���Jl� � J!111��4---.�11LV_�'.=='���'1`�u�!L��i.Y-�����J�=1� J� J-� -ti •. � � =_—}I� I � �1 _ � - =_ r r�"�T` . �-- �I _-� —1 . F!���. I �l�--..1` ��r-+ It;�+- I.!�I� �� � ��i.��'Ih—�' l �iy, � �I���� I��1� �r' �.T` il � . .' - - � r-��. . --�-4����;�1� . �1; '�1 '! Ll�� ',!I . �,1-.-1 i. � y 1