Death Certificate - Burger, Jay_5/30/2003�? ��� �ao�-alg��-�
GIBSO�!COUNTY DEPARTMENT OF HEALTH
800 S. Prince St.
Princeton, indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CSRTIPY
that accordiag to the recorda of the Oibeoa County Departmeat of Health,
JAY BIIRG$R
Died oa 04/18/2002 at 4:45AM
Residence
R.R.# 2
Ft . Branch IN
AgE dt dC9th . 48 YEdLB SEx: M
Marital Status: Married Color: White
Cause of death: Brain 'himor, 4 years.
Signed by: Anthony Stephens,hID
801 St. Mary's,Dr.
Evansville IN 47714
Place of burial Holy Cross
or removal:
Ft. BrdnCh IN 47648
Ddte Of buiial: 04/20/2002
Funer,al%home:-. 'Stodghill Puneral Home, INC
11� ����
� MAY 3 0 2003
J %�''`
G�asoN couN � v •nu�'TOR
��_ _ _ - .
-�' - �. .� 3�04 W. Locust Street
= � � Pt. Branch ZN 47648
- : � � � ,�.�� �. i�,��i
^ - -- Signed by
�_'� � � Gibson County Health Commissioner
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ti\
" 'S"E..A-�--,-`_� .
�� "_._ - Princeton, indiana OS/28/03
� ,_ -- Address Date
Recorded locally in Book No. 14 Page No. 37 Filed: 04/25/2002