Death Certificate - Elliott, Melvin A_10/28/1987RECORD UF DEATH
� .;
�:
�
GIBSON COUNTl' DEPAR'I'ITIENT OF HEALTH
PRI\CETON. IND[ANA
�
THIS IS TO CERTIFI', that our records show ;�SELVI\T A. ELLIOTT died
day yeer hour of deeth
stree[, hospi[al: rural
Age at Death f, 6 ceX n;a 7.�Color�4111t.? A9arital Status �ta i ad
yeers � v.�ri[e whether married or single .
Primary cause of dea[h giaen �aas Cardiac and R's�i ra�orv Arrest Cardiac Fai� ure
M aG'a i arcinoma of pa�zPay C; n rali d D b�l� �
Signed b}• HonPSto FPn�I �1 D tith � anri [i � � Pp}prch>> � Tn. _
phpsician or mroner . address
Place of burial or remo��al � ch; 1 nh ua Z1 at�n rri
. name o( ceme[en� � address
Dateofburia�°ust 14, 1937 Colvin Funeral Home, Inc. Princeton, In.
Funeral Dvector address
sr:�L
5. �:ne d .�i1 % L .�UN?7 � �'G�,l� i ���
Gibsnn Countc Healeh Ct(yimissior,er
Oakland Citv, In. Au�ust 20, 1987
xddre`-`- �a::
RecordedlocallyinbookNo. 11 PageNo 4�! Filed: Anmic; �� 19R7
t
�
I
u
�
�, .
i' '
I;
i'
r • �
i'