Death Certificate - Douglas, Mettie Celesta_4/6/1979RECORD OF DEATH •
�
GIBSON COUNTT DEPART\IENT OF HEALTH
PRINCETON, IND1�1\ a
THIS IS TO CERTIFY, that our records show METTIE CEI�ESTA DOUGLAS died
12/7/195� at 7AM RR #1 Princeton. Ind.
month dap year hour of death street, hospital, rural
Age at Death 5� SeY Fe • Color wh • \Iarital
}-ears
Primary cause of death given �vas Uremia
Signed b5� Harold G. Petit jean, MD
physician or coroner
Married
�rrite ��hether married or single
Haubstadt, Ind.
address
Place of burial or removal Wy1nu�_Hi l l Ft ,�� n�}1,��,
name of cemetery addre;s
Date of burial 12�10/50 Short & Holder Owensvi�le� Ind•
Funeral Director address
SEAL
0
s��aea � G�'/ �C �° ��o, .�a �i
Gibson County Health Co�nassioner
✓ .. .
Oakland City, Ind.
address
Recorded locally in book No. H-�4(�_Page No. 141Filed: _l�/14�50
�
date