Death Certificate - Caldemeyer, Roy O_4/2/1979�
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ItECOI D OI' llI:ATH `-!
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GIBSON COUNTY DEPARTriL•'NT OF HEALTH
YRINCETON,INDIANA
TIIIS IS TO CEftTIFY, that our records show ROY 0. ('.pi nF.MFYF.R ����
12 1 7 et 10 � lOAM Wirth HoGn. �ak l anr3 ('i t; , Tnri .
month day yenr � honr of dexth etreet, hoepital, rural
Aga nt Death �'��1 Sex M� Color_Idh_Marital Statua MarriPr�_
y�� write whether married or aingle
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Pi�mary cause of denin given was ACUte mvoCardial infarcti on
Signed by Gary HpuChins, D� na�an� �i+�y�nd
physiclan or coroner addrcea
Place of burial or remova� P_0�8y.Y.111E__ P�sey_v� l 1 a. 7nA . _
nnma o! cemetcry addrees
Dute of buria� 12/11/77 Stodgh> >> FLno�-a l uome F+. Aranrh. Tnr� �_
ilinerel DImWr addreee
� SEAL
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- Gr) G{���_� � ��%� ,��
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signea �% _
Gibson County Health Commissioner
Oakland City� Ind. 12/14 7�
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� Recorded locnlly in book No. 1'I-5z page No.�.�led:-1,2.�14,�7�
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