Death Certificate - Beloat, Carl B_2/14/2007GIBSON COUNTY DEPARTMENT OF
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
TH
THIS IS TO CERTZFY
that according to the records of the Gibson County Departmeat of Health,
CARL B. BSLOAT
Died oa 09/12/2003 at 7:30AM
Residence
R.R.�3 BOx 62
Princeton, IN
Age at death . SS Years Sex: M
Marital Status: widowed Color: White
Cause of death: Metastatic Carcinoma of Lung
Maaner of death: Natural
Signed by: Arun C. Kumar, hID
105 N. 2nd Ave.
Princeton IN 47670
Place of burial Columbia white Church Cemetery
or removal:
Princeton IN 47670
Date of burial: 09/15/2003
Funeral home: Colvin Funeral Home, Inc.
425 N. Main St.
PTiRCetOR IN 47670
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Signed by
Gibson County Health Conunissior_er
S � A L
Recorded locally in Book No. 14
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:.'.�'� IVW1-20
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Princeton, Zndiana 02/13/07
Address Date
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137173
Page No. 71 Filed: 09/17/2003
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