Death Certificate - Burnett, Rexia_1/13/1975�
RECORD OF DEATH � �
I GIESON COUNTY D�P9RT�IENT OF FIPALTH
� � PRItiCF.TO�, I\'DIANA
THIS IS TO C�RTIFY, tliat otir records sho�v
sFxin suPrrF,r
;;
Dec. 3� 197� at3e15 Pbi Gibson General uosp. Frinceton
month day� cear hour of death streei, hospital, rurY ,
61a1e ;�'hite � Married- �
Age at Death79 Sex ' Color ��'Iarital Status �� "hetl,er marr;ea-or s;ngte
years
Primary cause of de�th given was
Acute Conaestive Heart Failure .�
� Hvoertensive Arteriosclerotic Heart Disease
S—��� t�rty�r_n. . 113 �• Nain St., Frinceton,'Ind.
Slgned b}_� __ address - -�
physician or coroner .
Barnett �'lberfield, Ind.
Place of burial or remo�-a1 aadmss -
name of cemeten� �
Date of Uurial 1�2���" Lamb Hedaes 14emorial Chaped Oakland Cit.y, Ind.
Funeral Director °��reSG � .
SEAL �
. �
�I � `��%1/� , ,��11/,? � 1�.+,�' �
�i+,,•y;.� i..-,�,:,•
Si�ned
Gibson Coimt} Health Commi=;ioner
Frinceton Ind. �' 1/9/75
address , datc
� 8 Pane tTO.-109 Filed: Januarv �, 1975
Recorded locallp in Uook No.
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