Death Certificate - Allen, Charles Amos_6/20/1990RECORD OP DEATH
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GIBSON COUNTY DEPARTIiENT OF FIEALTH
PRINCETO.I, INDIANA �
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THIS IS TO CERTIFY, that our records show CHARLES AMOS AI,I�EN ' died
2/27/78 at 6PM 710 W. Walnut Princeton, Ind.
month day year hour of denth atreet, hospital, rural _ �.
Age ai Deatli 7% �ek �le Color �'-'-te niarital Status Married
yeara ' write whether. married or single
Primary cause of deatli given was Pulmonary embolism
, �4
Signed by B• C. Brink, DO Princeton, Ind. i�
� physician or coroner address - „ �i�
�•-. -
Place of burial or removal Au�, st ta Winslow. � Ind�. -
' name of cemetery address ' X� `'
Date of burial 3/3/7$ Colvin Princeton, .'!Incl.
F�neral Director address �'
�� �i Cr`�I'?C G � � ' < �.Z�
SEAL Signed
Gibson County Health Commissioner �
Oakland City, Ind. 4/11/78
- address date
Recorded locally in book No. 9 page No. 58 Filed: 2�27I�8 ..
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