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Death Certificate - Camp, George D_5/5/1983KwJCORD OF DEATH �
�
GIBSON COUNTY DEPAPT➢IENT OF HEALTH
� ' PRINCETON, IA'DIANA � �
THIS •IS TO C�RTIFY, that our records show_� GSORGE D. CAPIP ����
Ju�,y 5.,_iQT�—at—],DiOSPM 442_li_.�.B�t. Ft. Branoh Ind
month day year hour of death � street, hospital, rural �
Age at Death 6� �ex_9��a ��o�• White hqarital Status �='I'led
years � � � _ write whether married or single
Prima�y cause of death given was Acut.ga mvQ�rdl9LLnfeTatlO*� , _
Signeci by
address
3- •
tixce ui Uul'idi Oi ieiIIUVa ' VR2�1L'L a��� — "' Ft. B2'anOh.�Ind,_� - .•
name of cemetery- � �. � address � �� ��� " ' . �
7/8/94 Isib Funerai Hemw F-L.—��'BASh�—�3t��
Date of burial_ '
� �- � Flineral Director - �� � address
- SEAL
Signed ��G,-"`4i '�l�}i�ii{Y1wu.'-Z �%i� —
Gibson County Health Commissioner
Princeton, Znd: vipf�4
8aa�� . aac�
Recorderi locally in book No.. _ H-51 Page No.__�_�Filed: ?./��n�
