Death Certificate - Clark, Agnes Florence_5/15/1978�
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RECORD GF DEATH
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GIBSON COUNTY DEPARTidENT OF HEALTH
PAINCETON,IYDIANA _
THIS IS TO CERTIFY, that our records show AGNES FI,ORENCE CLARK died
April 2,1962 a}1:04APfl Oakland City Hospital,0akland City, Ind.
month day year hour of death stx�eet, hwpital, rural .
Aoz at Death 88 Se,�emale Color lliarital Status��ridowed
years - -write whether married or single
Primary cause of death given was �oronary Thrombosis
Sig-ned byH.A. Peters D.O. Oakland City, Ind.
physician or coroner addres� .
Place of burial or removai �`-�-62 Montgomery Cemetery, Oakland City, Ind.
� name of cemetery _ address
Date of buriai �-�-62 Corn Mortuzry Oakland City, Ind.
Funeral Director addres3
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SEAL �' � Signe� �
• ' - Gibson County Health Commissioner
Oakland Cit.y, Ind. 5-15-78
� - address da[e
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Recorcied loca!Ip in book No. H-5� page No5 Fi1ed: �'-3-62
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