Death Certificate - D'Ambrose, Bernice J_7/13/1978�
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RECORD�OF DEATH
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CIRSON COUNTY LEPART1�iGNT OF HEALTH
PRINCETON, INDIANA
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TffiS IS :�'O CERTIF'Y, thut our records show_BERNICE J. D'Ambrose a��
�3/72 At 8:25AM Gib. Gen.Hosp. Princeton, Ind.
mont6 d¢y year hour of death etreet, hospitnl, rural
Age at Diath 55 sex Fe. Color_ � Marital Statua Married
Iyeare writc whethcr married or single
Primary cuuse of death given wsu+ Hepatic Failure
Signed by! Bruce Brink, DO Princeton, Ind.
' phyeicinn or coroner nddrese
Place of b�rial or mmoval Columbia Church Princeton, Ind.
- � nnmc of cemetery addresa
Date of bu,rial $�5/7z Kendall Princeton) Ind.
��. �neral Director nddress
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SEAL Signed �
Gibson County HcalLh Commiseioner
OaklandCity, Ind. 7/12/�8
• addresa date
Recorded l;ically in book No. 8 Page No- 55 Fi��;�8�%2
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