Death Certificate - Coomer, Henderson C_12/3/1982�
R1�RD OF DEA1'H �
� �
GIBSON COUN1'Y' DEPARTMENT OF HEALTH
, PRINCETON,INDIANA
THIS IS TO: CERTIFY, that our records
HENDERSON C. C00 ,NER
month day , year , hour of death street, hospital, rural
Age at Death �� Sez n'!• Color Wh. Marital Statuc Married
years '� � write whether married or single
Primary cause of death given was Congestive heart failure
Signed by �=• F. Carpertier, I�'D Prir.cetor, Ind.
phyffician or coroner address
Place of burial or removal I.O.O.F. Francisco, Ind.
name of cemeterp address
Date of buriat 12�1/E2 Colvin & Sor. Prirceton, Ind. _
F�neral Director address
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sEaL s��,e
Gibson County Aealth Coavnissioner
Oakland Citv. Ind. i2/�/82
addreas date
Recorded locally in book No. 7 Page No. �$ Ftiled: 12 3 62