Death Certificate - Anderson, Ezra Fisk_2/1/1989�
RECORU OF DF,ATIi
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CIBSON COUNTY DEI'AIZ'I'MEN'I' OF IiGAI.I'H
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THIS IS TO CE2TIFY, that our records show� EZRA FISK ANDERSON ���e�]
December 26 1965 HL 7:10 A:M. Gibson General Hosnital Princeton, Indiana
month dny yenr hour of denth street, hospitnl, ninJ
Age nt Death �� Sex Male Color WhiteMarital Slntus Married
yenrs write whether mnrtied or aingle
Primary cause of deaCh given was Lobar Pneumonia-8 days.
Signed by James F. Peck, M.L. Pr.incecon, In.
physician or coroner ' nddrese
Placc of burial or removal St. John's Buckslcin, In. _
nnme of cemetcry uddress
DaLe of burinl vecember 29, 1965 Corn Mortuary Oakland City, In.
Funcrol Director nddress
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SEAL Signed �'1/ �`�r'Y!� � '/�i„?%
� Cibson Conn6y I'IcnlLh Cor ssioncr ' � ' '
' � nnklanrl r.� �jt. -],1IIti�rv 'il'�9 � , _'
❑ddress dalc , .
Recorded locnlly in book No. � Page No. 120 }'����j: Gecember 31, 1965
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