Death Certificate - Ewin, Evelyn Laverne_12/30/2004GI BS[YJ COUNTY TH Fax � 812:,85$027 Sep '>0 2005 12 � a,
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; GIBSON. COUNTY DEPARTMENT OF HEAI.TH
� 800 S. ?rince St.
� princeton, Indiana 47670
; � g12-385-3831
; RECORD OP DEATH
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: t0at ac�cording to the records of the Gibsan County Depertment o! Sealth.
; � : SVSLYN LAVSRb78 SWZN
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Died on 07/14/2000 at 4:20AM
� ' Wirth Regional Rospital
j � , HWy 64 W2St
I i ;pakland City IN 47660 �
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Age at�death �� 64 Y02XS SeZ: F �
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liarital 3tatua:! Married Co1or: White
Cause I£ deatAe� septicemia l�1 days), beft HIiee Absceas {2 weeics),
j- �� ovarian Cancer (2a yeare ago) with Radiation,
; EnLeritis, 7ype II DM
Mauaeriof death: Natural
Sigaed�by: Terry Gehll�usen, DO
- Hwy 64 west �
� ONclarid City IN 47660
Place I f burial� NlontgomarY Cemetery
or rermoval': • .
� � oaicland City IN 47660
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nate of burial: o7J16/2000
homec Corn-Colvin �erai Home., Znc.
323�N. N13in.StTeet
02Y•land Ci�y IN �7660
Signed by
Gibson Connty H�1Lh CoIDmissio;er
Recordid locally in Book No. 13
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Princeton Indiana OS/2o/OS
Address Date
page No. 122 .Filea: t��ll�lL�""
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09-20-05 12:13 TO:G165017 COUNTY AS5ESSOR � •FROF1:8123868027 P01