Death Certificate - Douglas, Robert Welzie_6/21/1984RECORD OF DEATH
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GIBSON COUNTY DI;PAPTMT;NT OF IIPALTII
PRINCETO�i, IA'DIANA
THIS IS TO CERTIFI', that our rccords show �OBERT_FIELZSE_DQOGi,AS died
4/5/1961 1� RR#3 Owensville, Ind.
month day . year � hour of death strcet, hospital, rural
� 93 ' rdale I4hite
Age at Death 'Sex Color Tlarital Status Married
'� � Y�� write whether married or single
Primary cause of death given was_ Coronary occlusion
Signed Uy Glenn O. Dickenson, D.O. Owensville, Ind.
physician or comner address
Place of burill or removal Blythe Chapel Owensville, Ind.
name of cemetery address
Date of burial `����61 Laib Ft. Branch, Ind.
- FLneml Director address -
Gr%�'/��° ,�„
. , 'SF.AL $�gned �
Gibson County Health Commissioner
—�- Oakland City, Znd. 6/20/84
xddress ��
ocally in book No. H-49 page No. 116 ���
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