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Death Certificate - Champlin, Ruth_3/1/1974- RECORD OF DE:4TH : �'' ��!"`�"v •^��Q� . GIBSON COUNTY DEP9RT�IENT OF HEALTH ' - - � � . PRI\CETON, I\DIAATA . - " . `. . THIS IS TO CERTIFY, that our records sho«� F?UTH CHAMPLSN died. Feb.- 21, 1974 at�4PM �. Gib. Gen. Hosp. Princeton, Ind. . month �� day year - hour of death � street; hospital, rural . � Age at Death 7u Sex FamaLP Color WhitP Marital Status Widowed " � -. � � years � . : . . , � . ,. �. � -� ivrite:whether mazried.or�.=_ingle , Primary cause of death given was ' Pulmonarv �embollsm & emboluc �rt atr7um ._-Signed:by Vi�'all McCartv.. M.D. PrtnnPton, Tnd, • � ___ - � � physician or coroner . - � address - � � Place of burial or removal i. O. O. F. ' Rontnn � Tl l. - name of cemetery � , . - - � address - . � �� Date of buria] �/�4/7k C(21vin R- Snn PrtnePton, Ind � � � . . F'uneral Diiector - • - address � � ' \ � Y � - � n; ��.�� - - SEAL � Signed '- . ' � . - �- . . . � Gibson County-Health Commissioner _ , . � - . � Priticeton. Ind. . '�/�/94 . � . / . > . . � address . . . . � - date ,' q`� � - ' . - . .., . 4 . Recorded locally in book No. 8 page No. 93 Filed`. 2/26/7. - . � l . . y ,r i . � .. 1 ,. .d � .. ,. . � , _ �'� �'+-^ y., i-' Y`"Y' � �S ��/ / .�. `��.� � ., a�9,t'wt `��'+ - �"�!'.�' �� i,1 J � �' - b y ��V . r+ (---.w.°-y,('ia�t � y�� r F�.i u 5'�` ��i � �{�� 4,; i . '�� k �(qy.� �m �� , ,, „ ; �' � �'' � '' � � "r,,��'3,� ,�0`� � ,� �. � . ��'' � � C� � y �� ;. .. . ��'I. (, ��, �FI' : (d,�� `�J .. . �.��_r ( r � . _„3 �r ' �.'�'� `` G ..,r-r.�..,�� ' �aninl.r�m �. �, � 1 - �;, �' Y-� f''� �� `,j' ((( A ' � ��, �'$1 �� ;,� .!.. �% ;�� if '� � ?f1�i'� �.. . I . , � � � e _ 11 � L `.L� � � ,�� { ��r�� k. , t—+� . � . =i ; • � � < � � �; ' � � � �� , �.� �� . i' � . ' � 1�. �� Y .�� ..� �—.� � { l� .� �� h'. .f�) � A. �l� 1 � �� ( � � �� „ �,� �� .� . "�, ; , � � �;�� ,"��,, , �� . •�� ,� . � ,;3� � ,�: �`�:-� �i� a �i �r ��-"� � � �i `- � ,�, 7.n� ti t�� ., ,� � '� �l ' �R j � ''�� i � �� ., e � t i -�� ,� f��a �.� �� . �; "..� ,k��i � ° � ,� .4�� j��.�:�, � ;�;y t t h., r a � ° � � � , � � e;,a I� I�)1 �'i yi r �'��' i �' ,,i , ��,� �� f�� 7 I �iP, �'f��t�, �i��^'�� ,' ' , ,,� r tf �� . (�w� �a�.�i� �j. I if.+�. �.� C� � :!I , I 1 " ' ' - �� . �., � �, � . . , . �, . _ � � , ;, � �f � � � '� � � � � _ �� ; I . � n �{ _ .' � .�� , � 1 0 � ! � ( I p o ,� i. �P f'j I �J ; r , i l,.l' �,� 1 �`, ' ',. , ��, � � _� � � , � � , +�� . I �_!` ',��. ; � � ��; �� , �+ (� � j,l'� � y � , � � � > j� � �� ' � ', �: . ,� �) � � S �f�,��' � d 't�� '� ` 7J I �' ;��,'7 �' � , , � n ;.�, . a � i � � � ,� � �� 's� � ��IF' �f �iC I ��'��7 a� } , � �� ,', 'i ti%�*j��1 !�j`i`� l ��.�I�j�l;1r,� ? ' � ..� �� 1 �, i�' � r � � �.) C � , ��' �".� i� _ ., ' � � r � . ; �� 1 _ �5 " .� , , - 1 , � . ' r I .. � ;� > � ,� . , ; r �� ;�� , '� �� . � � ,� � iU �. ,� ' � � � �lJ o , .. ,, � L e i t � 4 L � r�, �A � � �� ... �r � ° � � '� � �� . �9 ,� _ _ ,_� - .V � _. � _ �Sr�� _ � , . .�'�„ .. . �� t�`JO �, �� 0 8 �:�`'�i �i ,� . �� ,�, �r 7��:.s`,� �� n� �� , . • .__. � ,� o �° o . s �8s y MC �o .n m :T m V! C m 7 G� n n r a r QS ., l I a � 0 +i �I