Death Certificate - Douglas, Darrell Arvin_5/6/2002.... . ._ .:.._ ..............
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RECORD OF DEATH
THIS IS TO CBRTIFY
�that according to the recorde of the Gibaon County Department of Health,
DARRSLL ARVIN DOIIGLAS
Died on OS/O1/2002 at 11:26AM
owensville Convalescent Center
Hwy 165
Owensville IN 47665
Age at death . 83 Years Sex: M
Marital Status: Married Color: White
Cause of death: Pneumonia, Alzheimers.
Signed by: Chester Burkett, M.D.
P.O. Box 550
POSEyv1112 IN 47633
Place of burial Clark Cemetery -
or removal:
OweRSVille ZN 47665
Date of burial: OS/04/2002
Funeral home:
5 E A L
Holders Funeral Home of
Gibson County, Inc.
P.O. Box 518
Owensville IN 47665
Signed by ��G'���"""�„�it �/`(/
Gibson County Health Commissioner
Princeton, Indiana OS/06/02
Address Date
Recorded locally in Book No. 14 Page No. 38
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Filed: OS/06/2002
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