Death Certificate - Clift, Martha Life Est_6/8/1995i�
6
GIBSON �UNTY DEPARTMENT OF�ALTH
800 S. Prince St. `
Princeton, Zndiana 47670
. 812-385-3831
RECORD OFDEATH
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
MARTHA N. "SZMMONS" SMZTH
Died on 06/04/1995 at 10:25 PM
Forest Del Convalescent Center
M 102o vine street
• Princeton IN 47670
�
Age at death .
Marital Status
Cause of death:
Signed by: ,
93 Years
Widowed
Sex: F
Color: Black
Bilateral Aspiration Pneumonitits, 4 days.
and ASH with CHF
William R. Wells, MD
510 N.Main St.
Princeton IN 47670
Place o£ burial Oak Hill Cemetery
or removal:
Patoka IN 47666
Date of burial: 06/09/1995
Funeral home: Kendaii Funeral Home
S E A L
520 S. Main St.
Princeton IN 47670
Signed by ��'y;"I E�'�G'° �`�'�
Gibson County Hea h Commissioner
Oakland City, Indiana 08/17/95
Address Date
Recorded locally in Book No. 12 Page No. 117 Filed: 06/08/1995