Death Certificate - Coomer, Jacob Lawrence_8/17/1998GIBSON�UNTY DEPARTMENT O�EALTH
800 S. Prince-St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
� that according to the records of the Gibson County Department of Health,
JACOB LAWREHCE COOMER
Died on 08/24/1994 at 12:54 AM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 76 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Refractory Congestive Heart Failure
Cardiomyopathy- Ischemic
Pneumonia-Acute
Respiratory Disease
Signed by: Arun C. Kumar, MD
105 N. 2nd Ave.
Princeton IN 47670
Place of burial Columbia White Church Cemetery
or removal:
Princeton IN 47670
Date of burial: 08/27/1994
Funeral home: Colvin Funeral Home, Znc.
S E A L
425 N. Main St.
Princeton IN 47670
Signed by vl1 �'�'/ �9 G'• ��'A'',� �
Gibson County Hea1 Commissioner
Oakland City, Indiana 09/O1/94
Address Date
Recorded locally in Book No. 12 Page No. 96 Filed: OS/24/1994