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�'(NIF. EDERICKINEWTON1 ` �% �I`,%III I G �1"� q� IIytA��j NII[l ``
. DAN.FREDERICKINEWTON f4c Un Co I MACE. I .)12.33 PM.cidy r,_ -02112120,180\`�1
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AVI AVI N!NEWTON - �`►~ 6. n\\ �ly� �M� \�i MAE EWTON. „11.11... h+l ;Vv si Iimes`cnci n �lln v"�."r. '.
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JUSTIN RN .,,-0.n;. NURSED �'`C 600.MARYiSTREET EVANSVIL%LENNL47.7_47 t
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. 28,Part'I En er he Chain Of FVrnta-,Diseases lryuries_!Or Canpllwtwni,abat DvaAry Ca od The Deatx��(DO,Not4Enter• en .) ox •On
f "aL �enIy Doe Cruse 1 -�. /\ % ,Death '%".
As Card ac Attest;Res Ira.V Arrest• '7^ennarlar.0 i∎ Ian w�o $ o. „ n� 1 \�
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ne A.�En ,,a„ Und,,,„„Cause(,,seas,OrIry,ry, att(matetl ,Ttl\bJ 1i�\//11R � i \ / yiptnr�/a�{„11� ap) +fir
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CONGESTNE HEART:FAILURE CHRONIC RENAL FAILURE 0 n
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L•34 Data Of Injury(MOntNDaynresO-,,111 35. Tte0l Inju_ry.I II LiflYPace effAll�ry(EG;Decedents Hme•'Cm_sm+ctionSe'Resafrant repded Area J) I
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a3 Name; aess Aid LPCade Or Person Cerbfyng Causeor.Deam �•^ \ '%.`"...%,.......7.4.„ i44Ct.cen N,r:da < ICLI Cert.5ed
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