Death Certificate - Embree, Bernice P_1/23/1990G S 8 S O 1\!'
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[: Ci U 3V T Y sa ����r. �t rA E` ��r
S00 S. Prince St.
Princeton, Indiana 467070
S12-385-3II31
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TN:S ?S 'ib CERTiFY
tSat according to the recoi-ds ot the Gibson Ceenty Departmer.t of Health,
!slol7i'/CN���YI:)C7��1
Died on O1i07/i990 at 6:55 P.M.
Gibson General Hospital
1808 Sherman Dr.
Princeton IPJ 47670
�ge at oeath: 77 Sex: M Color: White Marital Status: Widowed
Cause of d�ath: Diabetic Coma-Ketoacidosis 2-3 days
?nfluun=a. CHF
Sigr.ed 'ey: Wi 1 I iam R. Wel Is
510 N.!iain St.
Prince'ton 1N 47670
Ylace o: burial Warnock Cemetery
er remo��al:
Frince�on IN 47570
Date of burial: O1/10/1990
�uneral hom==:
S E 1 L
Colvin Funeral f3ome, Inc.
425 N. Main St.
°rinceton ?N 47670
Siyned by __ "`=�!_)�'�?�_G._ �'i/�/�f
6ibson County Health .onniissioner
OaF:land City, Indiana O1/16/90_
Address De,te
Recot-ded !ocaily in Ceo1: tdo. ?1 Pa«e No. 107 Filed: 01/1:;/1'l'7r�