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Death Certificate - Clevenger, Willard A_1/8/1976
RECORD OF DEATH �:-,.� � � 0 GIESON COUNTY DEPART�IENT OF HEAL'rH PRINCETON, INDIANA � THIS IS TO CERTIFY, that our�rFCOrds show WILLARD A. CLEVENGER died .Tan. 1, 1976 day year AM � 1)18 S. Gibson hour of�death Princeton street, hospital, rural - ,`Ta� ' t�„{ �e�, Married Age at Death �� Sex e Color,.���-Iarital Statu� �.;te whether married or single -� }•ears � ' - . .� ' � ! � Mvocard ial infarcti orL '- Y Primary cause of death gicen was . Si ed b• James F. Peck A?.D. • . � y a�dress . . . � physician or wroner - . � - - ' .. . . , . Place of burial or remocal Sollman � � � - ' name of�'cemetery � � . � � . a< <lre s • � . , .> : - .. . • . . . ,, . .. . . . - . . . .. f ' 1�3�76 F' Colvin � S�n —�-n'' ,���� , , Date'of burial address - � � � . � �: Fvneral Dimctor . . . : � t . - � - . � � �� � � � /%, �' " � /.�: � � ._ � ) �� , :. (ilJ GY /��y2�.� `�� c k?'�j�. 4 SEAL � . Signed '. , � � � . -� ' ' . Gibson County Health Camm�ssioner � _ s ::. ' - Oakla-�d C• � � Tn� 1/E/76 ." . � ' � - � � � � � . . address . . date - . �. ! ' . _ . . . . . . _ . . � '♦Recorded lceally �n book No.— Q', Page No. 19 Filed:�I� � .'' . :F, _ ' . � _ , � y — " ' } ` , �` � x ,:�. �° .; , � ��r . \V •, �..r `.... r.S ri. .,,�'?�'S .� . „"'� v ... � ... . _ a .. .,� . . _�..� J, . .+, _...,.._.. .-F::.�'_�iv?`. .� . _ � _ _.