Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
Death Certificate - Dawson, Edna M_10/31/1973, s « ,�.{ - = � vr ..-e��r�zcr.��za :t f r �4.o^i rw.,*, . 4� �°�
1 -t �#i .>a. _t �.�_ . , ,'.. �' � -'�'k� 57� a t �µ .
� l� ` ' . . • . . b {� � Y 9 • � � ��.
^ RECORD OF DEATH:�t ' , - �_ i.-, � : r , _ . ' , r- `" ! �' �` ' f � Y`s 'r
,« ,'
" GIBSOIV COUNTY DEPARTMENT"OF HEALTH .°� � `j_ " �' '
. . � . '� - .- : �} -' - °� � - ' :PRIVCETON, I�IDI.aNA , . ,�' �;�� 3• �-- .:,�'s;_?;.
; . • s � . : -_� � . . � ..' . .. : i • '.` � � i• �`'i'-
. � r - . �, � . • . ; ,f, ��� �. ,
•- TfiIS,ISj-T0.CERTIFY,.that our records sho�r `•� — L�-/_LL�-�B�r���* �=` died ,�
- .' - . ;'. ' , ' ' ,I,.� /� //'��/_��1_-- J/�
9 t , �t }` '/i ..� ��•� � J �Si/f.a /�.1�^^—^�a
:1'
, � � y . j/ ._.
$ �_—� s. �
-� month :�� � • day _- ;year _ . i ' ..hour of death ' ',+� etreet, h p�tal ruial _���
_ j �.; _ � i.�/'•1. , i, ' � �. , � � ���.� �. Y- {�'v.� }<' i� ; t. :
Age at Death �C�Sex��ea�a�Coloi• ��t�'L� �����. t <' r � r�,�
- • � y�� . _. ' �. � . , . . ' � -, «�nte �. hether marned'or smgle , ; > '�' :
, •
p�. � � { '' . �.` � �. st � F r - � ...�/ . � � . j. i v t S �a �� � «,
Pr�mary canse of death grven �cas---i��%� ,/Y�� �-�—�c e. � Q�� ' „.
' + . +r j 'l .� � `• � � <.-.tP4 ¢ ��i.
i 3 �. . , . i �. � ' ' i . ��. �. x. � _ - � - ( . ' . . Sj • �_.�s �,.�..,
s - . ._- �:��,__' �_ � � O ' � f� r � 1�.
� . .Sl$'II2d bj' " -(4'� � ' �(,!!t� ✓ ' . � .
� _ phy�ician or coron ..' ; � � .. .., _ address � �k�,� i.. � � � • <�,
...:'-, :. . _ - � n. ° . i�c �i
� . Place lof burial or remov� —�a� " (/ � . ` ,; '
.. _ � , �. � . . t . , �,,. ame cemeteD .: ., , "., '' �addzess � ..' , S ,' " i � e. .
` ...i ... .. ... • p . �% y� . � ' ..
Date of�burial�—��--ia.����yD �'" • a�"�A-t.rn���i..e� - �.:i
� '
� � tineraC Dimctor / addr ss _�' � �_ - ' r � -
. ..' � " . �_-J / ,,. . t:. _ - a ��j � � % _ � " �� � ' ' � ^ ti._ .
(C� ,( / ,a � ��� tY_
; � SEAL ' _ 5���'—�,� -�
- I �'` . � u� - " ;.•,i.:- � ' - � Gibson Coun y- ealth Commissio�fer ' ;, �,.�;-
.,. .t � .x � � .a= . �..Q -,' //n ..- �. +t,l,• . � /-,- /"�.�i
' � ' � � - - - � i � � - �Y�=-�`�^„�- . 4 �^�'" !o !�
. u �+� �T_ ± , _ . ..:2 -address €- �. _,. -' i' �date'
� 1 � �y . �..�:tF -..', . . . �' ?... ... . A. .�>. r ° .: . ,_ 'ti•
i �o� f , • �
, - Reeorded locally in book Ao.•,� � � PaQe No x : ,? ;f � # ; � .
r. • . `cd ,�.: c .,, j �:.'
F f) ..� "i +. i _ ; . ' . _ , ,. t � e 0+ -
�iti 1':.i _ ' i. � _ i � - , _ � � .t ._ .
I �__ _ _ —ti _�_.._ ! __�_v 5 �� _i� _ � ? •F�•It ` �,'+ . 1 ��� ;
.s �