Death Certificate - Clem, Agnes Ruth_8/28/1978�
RECORD OF DEATH
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GIBSON COUN1'Y DEPARTRiENT OF HEAL'I'H
PRINCETON,IND[ANA
TfiIS IS TO CERTIFY, that our recorda show AGNES RUTH CLEM died
6/15/78 a+ Gib. Gen. Hosp Princeton. Znd.
month day year hwr of death etreet, hospital, rural
Age at Death 77cex Fe' Color �' Marital Status 1�7arried
yeare , wrlte wheiher married or etngle
Primary cause oP death given was Acute Congestive heart failure
Signed by R. E. Weitzel, MD Princeton, Ind.
phy�cian or coroner address .
Place of burial or removai Decker Patoka� Ind.
name of cemetery address "
Date of burial 6/17/78 Keddall Princeton, Ind.
Fl�nerel Directoz aaarese
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SEAL gignecL �J �',
4'' � Gibson County Health Co ' ioner t,
Oakland City, Ind. 8/2$/�8 ,�
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Recorded locally in book No- 9 page No- 65 �;��; 6�20�78 ����
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