Death Certificate - Goodman, Jere A_12/9/2010GIB� COUNTY DEPARTMENT � HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CBRTIPY
that according to the recorde of the Oibaon Couaty Department of Health,
JERH A. GOODMAN
Died oa OS/20/2001 at 2:OSPM
Residence
1110 Angelia Dr.
Ft . Bx'anCh IN
Age at death . 65 Years 3ex: M
Marital Status: Married Color: White
Cauae of death: Metastatic Non Small Cell Lung Cancer, 7 months.
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Sigaed by: Edward Fox, M.D.
801 St. Mary's Drive
E1�anSVille ZN 47714
Place of burial Scotland
or removal:
Scotland IN
Date of burial: OS/23/2001
Funeral home: Anderson-POindexter
89 C Street
Linton IN 47441
S E A L
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Signed by
Gibson County Health Coavnissioner
Princeton, Indiana 12/09/10
AddTE55 Ddt2
351464
Recorded locally in Book No. 14 Page No. '_2 Filed: 06/06/2001
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