Death Certificate - Blaize, Fred K_6/22/2007'}!`.' .: ...:�':L'__ _ ' . ___.
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d COUNTY:;DEPARTIv1ENT� �i
800 :S:°:Prince;St.
Princeton, 'Indiana 47670
812-385-3831
RECORD OF DEATH
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H E;.A L'I'l-1
THZS ?S TO CERTIFY
that accordicg to the records of the Gibaoa County Departme.^.t c� HEd:_�:,
FRED K. BLAIZE
Died o.^. 06/2S/2003 ac 2:46AM !
Gibsor. General Hospical
1808 sherman Drive - �
Princecoa IN 47670�
Age at death . 62 Years �Sex: M� �
Marzta!�Status: Married Color: White �
Cause of dea[h: Sepsis, Diabetes,NO.^. Compl±a.^.ce wiC?: Dtedical C���e.
signed by: Edward White, D.O.
410 North MaiR SC.
Princeton ZN
�lace of burial uazletor: Cos:n Cemetery �
or res.oval:
F:azleto.^. �IN
Date of burial: 06/26/2003 - . .
Funera? ho3e: Colvin F1:^.eral Home, Znc.
+ 425 N. Mair. St. � -
Princetoa T_N 47670. � .
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Signed by � C". /'�c�_,� i._ C/`--
Gibson County Healch Con:��zss'_or.er
S E A L
Recorded locally in Book•No
,q
Princeton,.Indiar.a (�7i=(•�<�
Add:ess �
?age No. 66
a.
II
Fil�d: U'7/?U�2_0'1