Death Certificate - Dixon, Theordore Jr_5/7/1977RECORD OF DEATH •
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GIBSON COUAiTY DEPARTIIENT OF HEALTH
PHIA*CETON, INDI:INA
THIS IS TO CERTIFY, that our records show THEODORE DIXON. JR. died
1/28/1977 at AM 204 S. Barnes Patoka.Ind.
month day yeaz hour of death street, hospital, rural
Age at Death 54 Sex �le Color�ite �Iaiital Status M3rried
yeazs write whether married or single
Primary cause of death given «•as
Myocardial Infarction
Sianed b3- James F. Peck, M.D. Princeton, Irn
physician or coroner address
Place of burial or
Date of
SEAL
I.O.O.F.
name of cemetery•
7 Colvin & Son
FYineral Director
Hazleton, Ind.
addrnss
Princeton. Ind.
address
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// �,( i//�/,
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Signed
Gibson County Health Commissioner
Oakland C;ty. Ind. 2�2/77
aadress date
Recorded locall}• in book hTo. H'52 page No._z5 Fj]ed: 2�2���