Death Certificate - Doan, Jerry Lee_10/7/2003G�ON COUNTY DEPARTMENT�UF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
that according to the records of the Gibsoa Couaty Department of Health,
JBRRY LEE DOAN
Died on OS/OB/2003 at 5:45PM
Good Samaritan Nursing Home
210 Gibson
. Oakland City IN 47660
Age at.death . 84 Years
Marital Status: Widowed
Sex: M
Color: WY:`_te
Cause of death: Lung Cancer (Non Small Cell) 3/2000
Anemia, CHF, Hypothyroidism.
Signed by: Terry Gehlhausen, DO
H+ry 64 West
Oakland City IN 47660
Place of burial Albright Cemetery
or removal:
Mackey IN 47654
Date of burial: OS/12/2003
Funeral home:
S E A L
Corn-Colvin Flineral Home, Inc.
323 N. Main Street
Oaklan3 Citv ZN 47660
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OCT 07 2003
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Signed by �"' " G� t����' "v
Gibson County Health Commissioner
Princeton, Indiana OS/15/03
Address Date
Recorded locally in Book No. 14 Page No. 63 Filed: OS/15/2003
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