Death Certificate - Gwaltney, Josephine_11/12/1996° GIBSON C�TNTY DEPARTMENT �F HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
JOSEPHINB GWALTNEY
Died on 10/26/1996 at B:SOam
Forest Del Convalescent Center
102C Vine Strzet
Princeton IN 47670
Age at death . 76 Years Sex: F
Marital Status: Married Color: White
Cause of death: Congestive Heart Failure,
Severe Cardio Myopathy,
Signed by: Quentin B. Emerson, NID
802 E. Oak St. P.O. Box 185
Ft. Branch IN 47648
Place of burial Owensville Cemetery
or removal:
Date of burial:
Funeral home:
S E A L
Owensville IN 47665
10/29/1996
Holders Funeral Home of
Gibson County, Inc.
P.O. Box 518
Owensville IN 47665
Signed by �i'���'�'LI �"�'�'y✓
Gibson County Hea�.th Commissioner
Oakland City, Indiana 11/06/96
Address Date
Recorded locally in Book No. 13 Page No. 23 Filed: 11/06/1996