Death Certificate - Clem, Warner E_8/27/2002,.
GIBSON �UNTY DEPARTMEIV�OF HEALTH
800 S. Prince St.
. Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTZFY
that according to the records of the Gibson County Department of Health,
WARNER E. CLEM
Died on 04/11/2001 at 1:20AM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 80 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Cardiac Dysrhythmia (72 hours),
Acute Lypoxemic Respiratory Failure (96 hours),
Squamous Cell Carcinoma of Lung (2 years),
Chronic Obstructive Pulmonary Disease
Signed by: Krishna Murthy,NID
105 N.2nd
Princeton IN 47670
Place of burial Fairview Cemetery
or removal: RR # 2
Princeton IN 47670
Date of burial:
Funeral home:
S E A L
04/13/2001
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
Signed by °`�""`^"- � ��ip,�� y�,
Gi son County Health�mm'�Ssi�
Recorded locally in Book No. 14
Princeton, Indiana 04/16/O1
A ress Date
Page No. 8 ed:�4- /2001
� �� �
AUG 2 � 2002
J
GBSON COUNTY AUpITOR