Death Certificate - Corn, Forrest Elsworth_2/2/1983RECOKD OF DEATH
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GIBSON COUI�TTY DEPART\ZEATT OF HEALTH
PRIA'CETON. IA�DIANA '.
THIS IS TO CERTIFY, that our records sho�v FORREST ELS?VORTH CORN� - died
8/3/79 at 5�15PM Good Samaritan I1rs�. Home Oakland'Cit.y, Ind.
month day year hour of death street, hospital, rural
Age at Death 80 Ses M' Color f�h • h4arital Status M•
years � �vrite �vhether� married or single
Primazy cause of death given was Right congestive heart failure
Signed by �-�oward i9. Ropp, DO Oakland City, Ind. _
physician or coroner address
Place of burial or removal Montgomery Oakland City, Ind.
name of cemetery address
Date of burial 8�6�79 Corn Mortuary Oakland City, Ind.
F�neral Director address
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SEAL
!,t) �� �°,�� , �,v
signed �--
Gibson County Health Commissioner
Oakland City, Ind. 2/18/$2
address date
Recoided locally in book No. H-52 Page No. 57 �ied: 8/9/79