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Death Certificate - Haley, James Virgil_3/18/1971�% --� , ... -- : • . - . -. .. ----- • � ~ � , �+,.a `�. � . . _� � � � -' . � � r� � ' � , - RECORD OF DEA H . � ,_' ' • . . `' ^== � � GIBSOK COtiNTY" DEPAR'Cb4ENT OF HEALTH � :y,,. p � \�� • . � � � PRI\CETO\, I\DL4NA ' . •. , " oS sJ.ti],Jy p ' ; ;a � � . . . . . . y , �, .�.�.�- � �. �THI� IS TO GERTIFY, thatour records sho�r JAMF.S sIZ�GIL_H�LSY � � �died �-�'� . �. Nov. �� :. �;2j 1970. at12�15PM'+lirth Memorial Hosp. �. � ' ''` � ��.month � �' da>� � year � hour of death.p8klaIId Cltr t, " - . -... . . . . . . . _ � . �P� �4�1�, rural . ; . „ ✓ . � Age at Death_fifi—Sea_MalE " Color—;,•r��te v�,.I.�g�• years � �orite u'hether marned or single ; .,' . : �. , . . �::" - _ . . , .� . . . .: : Primary cause of death.given�.was—AcliiA Mv_o�ardia]�I-afar�-tio.^. - '"�' _.-, . - . . ' • _ �. " �' S�gned b>- '_Wm. E. DYe� MD Oakland �S�,Y-�-?D�, . • . ... _ ; y • � _ � - � � ph�-sician or coruner � • . . address � � . . - �;, �' Place of buiial or removal' A1�zT1�qYit�.eme��g �A^�e�c, ��r� , ' � . - �• name of ceme[ery � address � � , . �,•Date of bur�al ' 11 2j/ZO Cprn t�'Lottua�y na}}}��,�,AAZA]d�� 3c, ;r!�. - �� Fimeral Director / I � �r[�c dress . � � �- i . . SEQL � . Signed '` ., "I I uY�1 �� /u �r _ • � ,. / ��t, �� ' � � - , Ci -on Coimty Health ommiss�oner . . � . •�:0�_ . _ /'.�... '- . . . . . . ;�, �; . ;iS ''; r :, � . ,P.ecor� :.. . Princeton. Ind. • '}/18/7Y address . � Date No. l� I�51ed: 1Z�1�7� ;