Death Certificate - Barnes, Harold_1/14/1964_ _ j
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RECORD Ok' DEATH
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' GIBSON COUNTY DEPARTMENT OF HE9LTH
_ - r PRINCETON, INDIANA , �. � �
THIS IS TO CERTIFY, that our records show y`�-�+� � �.-a.t:�..�.a ' died
�12an � 1 s `k / 4 L 3 a�/ � �� �y �..I
_ month. day year � hovr of death street, hospital, rural -_
Age at Death�—Sex �� Color �^''�-�= �-'e
. � ; � yeais � � . - write whether married or single
Primary cause of death given �sa� �� �+� �-h �-e � � ��-s-� �
%�__ , ,_ / _ . 11. ._,c �_. D. ' _ - .
Signed by �---- ` �
: � . phpsician or. c o
Place of burial or removal�,iL�
dt
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address '
7 w iD i �- �
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- - � name cemete'ry - . � address � .
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Date of burial 3 - l �- /�G3 ��^^-'�- �"c�n��-.�P � ��� ' �`f � -
� ' � � - � Funexal Director � � � address '
SEAL .. Signed I` S S%.o�:��u..� �'yl �
' .. . - � � . Gibson County Health Commissioner -
- . . ' ' _ . � � � . / �/lt.»ct(�r.. � - � �x+..+� 1.'1 _'� 3
. . � . . . - - � :addiess - . . . . . date -
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Recorded locally in book No.�—Page No. �- 3 ' -
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