Death Certificate - Colvin, Ansel I_5/15/1995GIBSON t�UNTY DEPARTMENT OF �AL �-q
800 S. Prince St. ��� (� • �
Princeton, Indiana 47670 .��L�
812-385-3831
�69AY 1 � 1995
RECORD OF DEATH � ,y , „ �,
AUDITOR�
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
ANSEL I. COLVIN
Died on O1/18/1995 at 5:05am
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 78 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Acute Cerebro Vascular Accident (hours),
Atrial Fibrilations, Severe Atherosclerotic Heart Disea
Signed by: Rameshbhai P. Patel, NID
105 N. 2nd Ave.
Princeton ZN 47670
Place of burial Mt. Olive
or removal:
Date of burial:
Funeral home:
S E A L
Mt. Olympus IN
O1/20/1995
Coivin runerai nome,' In�.
425 N. Main St.
Princeton IN 47670
% /� � �' '�� --
Signed by :il�.:;���r'��/�.. =✓'--;,s. ,
Gibson County Health Commissioner
Oakland City, Indiana O1/20/95
Address Date
Recorded locally in Book No. 12 Page No. 107 Filed: O1/20/1995