Death Certificate - Ferguson, Alva Curtis_10/16/1975_ f.
RECORD OF DEATH • •
GIBSON COUNTY DEPART➢1ENT OF HE?,LTH
PRINCETON, IvDIA\�1
r
TAIS IS TO CERTIFY, that our records slio« ALVA CURTIS FERGUSON died
io/11/196�
mmth day year
5s10PM Gib. Gen. Hosp. Princeton, Ind.
hour of death street, hospital, rural
9ge at Death �6 Ser Male Color �'7hlte �qarital Status Marrled
� years write whether married or single
Primai•y� cause of death given �vac Carclnoma of left lune
S�nedby Vlrgii Mr��„-t____�;, M=n� Frinceton. Ind.
phpsician or coroner address
P1ace of Uurial or removal =,�^.,_p, �
� name of cemetery a dress �
Dateofbui�al 10/14/6� Colvin Pr Son Prtnr.etnn� Tn�.
Fwneral Director address
SEAL
VV �i'�%/ vr�"i L�`�-�'l C�.C/
SlaI1Q(1 I
Gibson County Health C missioner
, Oakland /oity, zna. io/i6/7;Y�
�� � address date
�'
2gcorded locally in book No. � Page No.—_ 18�Filed:-10/1Fi/h7
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