Death Certificate - Davidson, John T_4/30/2007STATE OF INDIANA
SS:
COWi TY OF GIBSON
� •
AFFIDAVIT OF DEATH
�
Comes now Barry Davidson, being duly sworn upoa his oatn
states that Jozz T. Davidso� depar�ed this life�on the 24�h day o•`
i
August, 1980, and at the time of his death was a resident o` Gibson
County, State of Indiana.
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BARRY AVIDSON
STATE Or ZIvDIFutiA
SS:
COCRVTY OF GIBSOii
Before me, a Notary Public, in and �or said County anc
State, personally appeared the abo��e named signatory, wno
acknoe4�ledged Clle et:ecutio�! o° the S3ii12 d5 }J2i�CJ' �YL'° dPQ C0=Y2CL
and the same was signed on the �"7 day of CC�fz,��, 2006.
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SIGNATURL: ��y.��-s_- ,�LL..�,��;,K1�lN
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P3INIED: �� ��. l A ti•.��K�::i itc._
NOTARY PUBLIC, PND I REST_DE
IN GIBSON COU.`iTr , STATE
OP INDIF� v
hiy Coeamission Exoires:
i"1 �-.�„��-` � �� �� � 7
THIS IIvSTRiTMENT WAS PREPAP.�D BY JAi�IES G
LA41.
I affirm, under the penalties for c
reasonable care to redac� eacn So-�
documer.t, unless reauired b-y laca. ��
�icDO�i.'v�D. IIZ. ATTO��i�Y vT
rjury, that I have taken
, Security number in �Pis
a