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Indiana Death Certificate, File # 62-032434
Name: Zan Mattox
DOD: September 17, 1962 @ 1:00 PM
Place of death: 823 West 6th St., Bloomington, Monroe Co., Ind.
Usual Res: 823 West 6th St., Bloomington, Monroe Co., Ind.
Length of stay this place: 20 yrs.
Age: 81
DOB: March 3, 1981
Place of birth: Indiana (Guthrie, Lawrence County)
Male/White/Married/ Retired
Occ: Stone worker
Father: William F. Maddox
Mother's Maiden Name: Nancy Deckard
Informant: Mrs. Mima Maddox (Wife)
Address: 823 West 6th Street, Bloomington, Ind.
Cause of death: Acute pulmonary Edema
Due to: Acute Congestive Heart Failure
Due to: Arteriosclerosis Heart Disease
Signed: Kermit Q. Hibner, MD, Bloomington, Ind., 9/20/1962
Funeral Director: Day & Carter Mortuary, Bedford, Indiana
Burial: Hays Cemetery, Lawrence Co., Indiana
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Indiana Death Certificate, File # 62-032434
Name: Zan Mattox
DOD: September 17, 1962 @ 1:00 PM
Place of death: 823 West 6th St., Bloomington, Monroe Co., Ind.
Usual Res: 823 West 6th St., Bloomington, Monroe Co., Ind.
Length of stay this place: 20 yrs.
Age: 81
DOB: March 3, 1981
Place of birth: Indiana (Guthrie, Lawrence County)
Male/White/Married/ Retired
Occ: Stone worker
Father: William F. Maddox
Mother's Maiden Name: Nancy Deckard
Informant: Mrs. Mima Maddox (Wife)
Address: 823 West 6th Street, Bloomington, Ind.
Cause of death: Acute pulmonary Edema
Due to: Acute Congestive Heart Failure
Due to: Arteriosclerosis Heart Disease
Signed: Kermit Q. Hibner, MD, Bloomington, Ind., 9/20/1962
Funeral Director: Day & Carter Mortuary, Bedford, Indiana
Burial: Hays Cemetery, Lawrence Co., Indiana
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