Death Certificate - Deffendall, Russell H_12/22/2003G'!gSON COUNTY DEPARTME� OF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THI3 IS TO CSRTIFY
that according to the recorda of the Oibaon County Departmeat of Health,
RIISS&LL H. DBFFSNDALL
Died on 12/OS/2003 at S:OOPM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 67 Years
Marital Status: Married
Sex: M
Color: white
Cauae of death: Cardiac Arrest, minutes.
rschemic Cardio hlyopathy, years.
Systemic Infection, xenal Failure,
Metabolic cirrhosis, Emphysema.
Manner of death: Natural
Sigaed by: Ramesh Patel, M.D.
105 N. 2nd Ave.
Princeton ZN 47670
Place of burial Columbia White Church Cemetery
or removal:
Princeton IN 47670
Date of burial: 12/10/2003
Funeral home: Colvin Ftuieral Home, Znc.
425 N. Main St.
Princeton IN 47670
S E A L
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DEC � 2 2003
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Signed by " `� G �i���" "
Gibson County Health Commissioner
Princeton, indiana 12/10/03
Address Date
Recorded locally in Book No. 14 Page No. 78 Filed: 12/10/2003