Death Certificate - Bush, Umphrey Madison_10/8/1975. \
RECORD OF DEATA
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GIBSON COUIQTY DEPART111ENT OF HEALTH
� PRIVCETON, INDIANA �
THIS IS TO CERTIF'Y, that our records show UnP�EY i�ADISON BUS3 d��
Aug. 24, 1951 10:40PM 105 E. South St. Ft. Branch, Ind.
a
month day yeaz - . hour of death street, hospital, rural
Age at Death 65 Sex 1^ale Color White Marital StatuQ �T7'ied
Sears write whether married or single
pr;mary cause of death given wa _ _._ _ r^r^^�T� rki�'ambosls _
Signed by
addrnss
Place of burial or removai Walnut H111 F+ a �8}3� �tq�� -
name of cemetery address
Da!e of burial 8�28�61 Laib r^uneral A�mP Ft �-B�gT16h ��it�
Funeral Director address
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Gibson County Health issioner
OaklandCity, Ind. 18/7/75
address' � " date
�\ �* H-49 Page No. 14i Filed:
Recorded;locally', ui book I�o. ���}
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