Death Certificate - Rainey, Roscoe_4/16/2014 k.4 VALVIDEF841URCH el UMW HEWN F 1 KFANT ,(i coy 11884 fI
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Evansville, Indiana
certifteC5ERTIFICATE OF DEATH
THAT ACCORDING TO THE RECORDS OF THE HEALTH DEPARTMENT j
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I NAME KOS, RAI?: F
DIED IN VANDERBURGH COUNTY INDIANA ON JU i 13 YEAR '010
= TIME OF DEATH 11 :06 P.M. MARITAL STATUS M RR I ED SEX 1+=.1 E AGE 79 RACE Itdi'dE
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hl DATE OF BIRTH 06/')7/1931
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•� PLACE OF DEATH DEACONESS HOSPITAL
PRIMARY CAUSE OF DEATH GIVEN WAS IiYPi1?LEMIC SHOCK I1
VAR!COAL BLEED
END STAGE CIRRHOSIS
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F PHYSICIAN OR CORONER (MA RI E? k(.+OR, Ni•D• AUTOPSY 7-:0I
'A PLACE OF BURIAL OR.ftEidOV.4L IJ;.;j'. J iJf)`•{F.=[}` CEMETERY MANNER NATURAL D7 `_i-E.3 sE
4 FUNERAL HOME .,vrt-IAA BURIAL L I "/)0
�_ ., .Fi1?17 ''.1:�h1C:'..T__i CHAPEL DATE OF o t4 (�%; t . _l.i0
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CERTIFICATE NUMBER Ii
Y'� OR VOLUME AND PAGE 000013)6 DATE ISSUED '
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NOT VALID UNLESS SIGNED E SEALED
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