Death Certificate - Douglas, Harry Andrew_3/2/1981--'--�
RECORD OF DEATH
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GIBSO\T COUNTY DEPARTI4EI�'T OF HEALTH
. � � PRiVCETON, INDIAVa - � �
THIS IS TO CERTIFY, that our records show HARRY AI`IDRFV7 DOUGLAS died
7/20/80 at 6:o5Pi�� Forest DelNrsg. xor�e Princeton„Ind.
.� month day pesr hour of death street, hospi[al, rura!
�,ge at Death 7� Sex �' Colm• �''m• Marital Status Nlarried
� years . � write whether married or single
Primarc cause of death e cen was Aspiration Pneumonia
Signed by Arun C. Kumar, P�?.D. Princeton, 1-^-d.
, pnyscian or coroner � address
Place of Uurial or i•emo�•al 4ak Hi ].l $ya nczri i l a�_�3
� � � name oi cemeten• address
Date of burial 7�23�80 Kendall Prnceton; Ind.
Funeral Director: address � . -
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; 'SE9L Signed — ° ���� � ��%
� �� � Gibson County Health Commi ter
Oakland City, Ind. 7/2�' 80
. . address date
Recordecl ]ocally in }wok \o. 10 Pa�e No. 16 Filed: ���3�80