Death Certificate - Gieseke, Sam A_12/27/1991�
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GIBSON COUNTY DEPARTMENT OF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
-- 512-385-3831
R E C O RD O F D E A T H
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
SAM A. GIESEKE
Died on 10-OB-1991 at 7:10 A.M.
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death: 61 Sex: M Color: M'hite Marital Status: Married
Cause of death: Respiratory Failure (immediate)
' Congestive Heart Failure (years)
Cardiomyopathy (years)
Generalized Anasarca (years)
Signed by: Bruce C. Brink, Sr., DO
410 N. Main
Princeton IN 47670
Place of burial I.O.O.F.
or removal:
Hazleton I�
Date of burial: 10-11-1991
flmeral home: Colvin Funeral Home, Znc.
S E A L
425 N. Main St.
Princeton Ztd 47670
Signed by K/��nl��`�'��
Gibson Count}� Healt ommissioner
Oakland Citv, Indiana 10/16/91
.4ddress Date
0
Recorded locall�' in IIook \o. 12 Page \'o. 22 Filed: 10-18-1991