Death Certificate - Churchman, Leo Roy_7/6/1978: �,
;
I
.'
�
i
t
�
,
;
,
�
�
�
; . .
� H�CORD OF DEATH
�
i ,
± GIBSON COUNTY DEPARTMENT OF HEAL1'H
f PRINCEfON, INDIANA
f; THIS IS TO CERTIFY, that our records show LEO ROY CHURCHMAN died
'
; 5/29/78 n�lAM _Gib. Gen.Hosa. Princeton.Ind.
mon;h day year hour of death street. hoapital, rutnl
Age at Deuth 73 Sex M• Color �•hZarital Status Married
yeare write whether married or aingle
Primary cause of death given was Cerebral hemorrhage �
Signed by Bruce C. Brink, DO Princeton, Ind.
phyaician or coroner addresa
Place of burial or removal Patoka Patoka, Ind
name of cemetery eddmsa -
Dateofburi� 6/2/7$ Colvin Funeral Home Princeton, Ind
� Flinerel Director address �
n
� G� �a�� �° � � �.v
SEAL ���
Gibson County Health Co ' ioner
Oakland City, Ind. 6/12/�8.
eaare8a a8�
Recorded locally in book No_ 9 page xo_ 65�1ed: 6/7/78
�
, �r
. 'r ,
. :: �. . .
u
�i
.:�
.�
/I