Death Certificate - Harper, Samuel Riley_6/15/1976RECORD OF DEATH �
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GIBSON COUNTY DEPr1RT\IENT OF HEALTH
PRINCETON, INDIANA
THIS IS TO CERTIFY, that our records show SAMUEL RILEY HARPER died
Feb. 1, 1965 at 4PM 222 S. Jack�on Oakland Citv. Ind.
month da}- year hour of death street, hospital, rural
Age at Death 8�_SeY N'a1 P Colo++�hi to \Iarital Status MarrieA
}•ears write �vhether married or single
Primary� cause of death given was ATteTloSClerotl c heart Ai�eAse
Signed by H. A. Peters, DO
phy_=ician or coroner
address
Place of Uurial or removal Mont¢omery �kland Clty, Incl.
name of cemetery address
Date of burial 2/4/65 Lamh F„ne+�l �a�e Oakland Citv, In�.
Flineral Director addrnss
SE:1L
�L/��/ `//�/�CC/'. �i"1 Cr`.1/
1
Signed �
Gibson County Health Commissioner
oak3and Clt�. T„�_ 6/15/76
address date
Recorded locally in book No. H—S� Page No.-64 F'iled: 2/2/65