Death Certificate - Chapman, Nola M_5/15/1978RECORD OF DE�TH
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GIBSON COUNTY DEPARIT�ZENT OF HEALTH
. PRINCETON.INDIANA
THIS IS TO CERTIFY, that our recortLs show NOT.A P,7. CHAPP;I4N d��
�*�18�7$ at 2:4�OPPli UJirth Hn�r�. (l�klan�i('ity, Tnd
- month day year hour of death ., street, hospital, ruzal
Age at Death 69 gex Fe . Color�L^ 11_114arital Status b1 rri �7
yeats . write whether married or single
Primary cause of death given was Coronary thrombosis. acute
i
Sig-ned by
- Place oF burial or
H. A. Peters, DO
- physician or comner
name of cemetery
Oakland City, Ind.
address
PHontgvmery Oakland City, Ind.
- — --- — , address -� -
Date of burial ��21/78 I�amb Hed�es Memorial Chavel Oakland Citv. Tnd
F�neral Director � addresv
,�'�,1 �'' '
• � SEAL ' `,,
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SignPri
Gibson Conaty Health Commissioner
Oak7.and City, Ind.. 4�2s��g
. , \.,
addreas . . date .
Recorded locail��in book No. H-SZ page Ir�o. �� F��; 4.�94�7R
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