Death Certificate - Deiss, Velma_12/21/1977� ��
� � �
.t.
.-, -
RECORD OF DEaTH . _ ,
GIBSON COUNTY DEPARTIIENT OF HEALTH
PRIVCETON,INDI4NA
T'rIIS IS TO CERTIF'Y, that our records show �T MA n TS4 died
121[�%% at��5 P� G�bcnn GPnaral Hn�_ PrinCatnn� TnA.
montS day Seaz hour of death street, hospital, rural
�ge at Death 7� sexFemale Colorti'Jhite i�Iarital Status Married
y�y write whe[her married or single
Priznary- cause of death given was Myocardial infarction
Siened by T mPa Park M n Princeton Indiana
physician or coroner . address
Place of burial or removal St. Bern3rd Gibson Co. Ind.
name of cemetery address
Date of burial 1 2�q/7�_5±�,�ah' i i F, �}[e�e Ft. Branch, Ind.
� F4ineral Director address
,. i i r,.�
SE?,L •
0
�;;'/� ,o ��
, G;� f G��'� �_ ��C c i'=,D
. gs�,� /
Gibson County Health Commissioner
Oakland Citx, 7n�7i3na 12�20/7�
address date
` 12 12
Rzcorded lccally in book�\o! !9� Page I��o._�__�'iled: � �77
, , ,., .l,r/` / �
��"V n_�.
/�C��f/'� C°+"
v
�