Death Certificate - Work, Stanley M Sr_3/22/1979� , � ' -
6
� RECOIZD OR DE:\TH �
GII3S0\' COUNTY DIi:P:AIti!'\IIi:N7' ON I�IP:1LTEI
I'RINCF.TON. I\DL�\A
TIIIS ]S TO CERTIFY, that our rec� rds show STANLEY D1. WORK
'_3/15/79 at 12:15P�+i State Hwy. 64 at So. RR Francisco, Ind.
, month day year hour of death street, hospital, ruml �
� �ge at Deatli 5i Sex Male Color ti�'�• riarital Status Divorced
� y-ears write e•hethcr married or single
Primary cnuse of death siven �;as—Fracture of the Temporal & Partietal Bones of ihe
' SkuI�—
S;x=ncd by Eichard_D.._Hichr.od,_Deputy Coz9ner __ Princeton, Ind. _
i��hyxir.i:m nr coron��r n�i.lr�•:�r -
� l'lacc of I�urial m• remo�•�il _I�Q_O.F. Fi•anci:;co� Ind. __ _
. munc of ccn�etcry ndJrrna
! Date of buri:il 3/i$/79 Colvin Princeton, Ind.
, FWneral Director uddress
SEAL
l� �j���{ � ZZ � ��i��•' [ �`' ,li
I �
Signed � � —
Cibson County Hcalth Commis;ioner
Oahland City, Ind. 3/i9/79
IIddL¢SS
Recorded locally in book No. H-52 Page ATO. 52 Filed: �19/79
�.� -
u�tc'