Death Certificate - Douglas, Harry Andrew_6/25/1980ItECORD OF DE aTH O
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GIBSON COUNTY DEPAftT11ENT OF HEALTH
PRINCE'fON, INDIANA
TFi1S_IS TO CERTIF'1', thut our records show xARRV p��y���� died
month da car hour ot deat6 V -`� °°�""�""`�-• —
Y Y strect, hospital, ruml
Age at Death �Z • SeX M• Color �' Marital Status Married
yenre � write whether married or r:inglc
Primary cause of death given was Acpi ration Pneumonia
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Signed by Arun C. Kumar, M.D. Princeton, Ind.
_ phyaicisn or coroner ,. _ _ uddreas
Place of Uurial or removnl— (1ak Hi 11 F.v3�yi11,�, Tnd�
name o[ cemetery add�csa
D�te of buri� 7�23�80 Kendall Princeton, Ind.
� il�neral Director nddress
SEAL
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Signed
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� Cibson Cuunty He�ith Commis cr
� Oakland City, Ind. �/23/80
� ' addrese date
� Recorded locally in book A'o._ 10 page No. 16 �led:.
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7/23/80
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