Death Certificate - Coburn, Kenneth W_5/2/2003GIBS� COUNTY DEPARTMENT C�iEALTH
800 S. Prince St.
, Princeton, Indiana 47670
812-385-3831
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THIS IS TO CERTIFY
that accordiag to the recorde of the �ibeon County Department of Health,
KSNNSTH W. COBIIRN
Died on il/12/1997 at 9:50 PM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 65 Years
Marital Status: Married
Sex: M
Color: White
Cauae of death: Cardiac Dysrhythmia, 48 Hours. Severe Left Ventricular
Dyafunction, 10 Years.�COronary Arteroscleroeis, 20 Years.
Hyperlipidemia, 25 Years. 'type 2 Diabetes Mellitus.
Signed by: xrishna.MUrthy,hID
105 N.2nd
PriRCetOn IN 47670
Place of burial I.O.O.F.
or removal:
Francisco IN 47649
Date of burial: 11/16/1997
Puneral home:
S E A L
Lamb-Basham Memorial Chapel
226 E. Washington
Oakiand City ZN 47660
,� G �'���
Signed by
Gibson County Health Commissioner
Princeton, Indiana OS/02/03
Address Date
Recorded locally in Book No. 13 Page No. 50 Filed: 11/20/1997