Death Certificate - Clem, Buell Emmit_6/12/1975RECORD OF DEATH
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GIBSON COUNTY DEPARTIIEtiT OF HE9LTH
PRINCETO\', I\DI�1N:1 -
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THIS IS TO CERTIFY, that�our records sl�o�e__ BUELL Gtft•'•IT N' died
. [4ay 10, 19'%5 at 11 � 55+�I�� Gib.Gen. hosp Princeton. Ind
";` � month day year �_ hour of death
. street; hos?ital, rural
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' Age at Death �� Sex i•isle Coloi• ��'hite _�2arital•SCatus b?arrled
years � �arite �chether married or single
' . COYI¢@StSVP.
Primarp cause of deatli given �ras Chr�r.ic fieart Fal re ;
Sie�edbe A » k�ot+zel,i' D �� t�
ph}•nician or coroner ��S
• Place of burial or removal " At_k.in�on�^.h3_pQ1 _Oatss.iii �� �
� ' , } name of cemeterp . ;.ddress . � -- �
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Date of burial__�/12/7 S ' (`�nn t.t r ��, nfly��anc���t�,--�n�,
F�neral Director address
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SEAL Si�n�ed T�'`'"`�Cr'y' ►�"� �%l�
Gibson County Health Commissioner
_ Princ=ton;..Ind. 6/2/75 '
' � . nddress - date
Recorded ]ocally in book No._F�� Page Vo._�_Pi]a�;_���5���
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