Death Certificate - Burns, Dewey W_9/20/1984P.ECORD OP DEATH �
�
GIBSO\ COUNTY DEP:IP.T\IENT OF HE:�LTH
PRI\CETON,IVDI:INA
TFiIS IS TO CERTIFY, that our records show nFt?FV ta _ nriRt�*c died
3/15/8�? at 3:40e��1 Gib. Gen. HosD,_pxin �, Tnd_
month day yeaz houz of death street, hospital, rurai -
Age at Death " $6 Seti ^?ale Color �ite �lfarital Status i�tidoo;ed
years wriie whether married or single
Priman• cause of death e ven «-as Acute conaestzve heart failure
Si�ned bp �
Place of burial or
Da*e of burial
SEAL �
. C. Kumar, P?.D,
physician or coroner
� � ' Z"OV14dIICe
remocat
name of cemeterp
8/17/84 Lamb—Hedaes
Funeral D'uector
.
Princeton, Ind.
address
['C3IIC15CG� 1T'i3. ' � �
address
& Basham Oakland City, Infi.
address
�U ��n% � � . i�i,�%
��
• �ignen
, Gibson County Health Commissioner
� Oakland City, Ind. 8/29/84
address
Recm•de8 localli�'in Uook No. 1� Page I�To. 12 8 Filed: $/ 29 / 8 4
date