Death Certificate - Arbuthnot, Jerry W_8/21/2001WX'r20-2�1 16�57 ELBERFEI.D ST HFl�MC-Fa�.1B5TR P•��
GIBSON C�UNTY DEPARTMENT (� HEALTH
800 S. Prince St.
Princeton Indiana 47670
812-385-3831 ��,��/.�
RECORD OF DEATH f��' ��'F'
TBIS IS TO CBRTIFY
that according to the recorda of the Gibaoa County Aepartmeat of Health,
JSRRY W. ARBVTBNOT
Died on 02/06/2001 at 10:30AM
Residence
R.R.# 1 Sox 490
Ft. Branch ZN
Age at death . 66 Yeare Sex: M
Marital status: Married Color: White
Cause of death: Metastatic Proetate Cancer
Signed by: Ricky J. Ballou, MD
�06 N. Burkhardt
Svansville IN 47715
Place of burial I.O.O.F.
or removal:
Francisco IN 47649
Date of burial: 02/09/2001
Puaeral home:
S E A L
f � E E �,�'
AUG 21 2001
G�OUNTY AUDITOR
Stodghill Funeral Home, INC
304 W. Locust Street
Ft. Branch IN 47648
Signed by ""'"" `_ G'��"".,�'�f �vY/
Gi son County �eaTtFi CotTmiiss oner
Princeton Zndiana o2/14 O1
-�dYegg Ddte
Recorded locally in Book No. 14 Page No. 13 Filed: 02/14/2001
TOTf� °.02