Death Certificate - Chambers, Glen G_10/14/1987R.^,i,"v7tD OF DEr1TH
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GIBSOi\' COUtiTl' DEPARTD•IENT OF HEALTH
PRMCETON, INDIANA
THIS IS TO CERTIFY, that our records show (�
R died
9 � 87 a 1:50 P.M. Gibson General Hospital Princeton, In,
month day pear hour of death
street, hospital, rural
Aee at DeatFt__$2 ces Male
�.e8�s Coior t9hite�l,;��a1 StaCus Married
write whethcr marricd or singlc
Primary cause of death given a�as Res irator Failure, Extensive Spread of Cancer-
Luna Concxestive Heart FailurP
Signed
physician or mroner
Place oC burial or
name o( cemetery
Date of burial Colvin Funeral Home
Sept . 9� j 9 g 7 Funeral Director
SEAL
Princeton, In.
address
aute, In.
Princeton, In.
address
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Signe� � ' ��'z/ � .. ;�<:. ��� _..
G�bson County Health Commissioner
address 10-8-87 '
dnte ,
Recorded locally in book No. 11 Page No. 4 6 Filed
9-10-87
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