Death Certificate - Higginbotham, Clarence Bertis_2/18/1976, .�� .. . . . � . n
\
' ' . �,, �._: �s - _ . ,
RECORD OF DEATH • � -;
- � GIBSON COUNTY DEPART➢4ENT OF HFALTH
� PRI\CETON, INDIA\:1 �
� . _ _
THIS IS TO CERTIFY, that our recoi•ds
� �>,«��t�`�,,,�,� �.� "'�'�°
Feb. 1'i. 197�at 1�10PM Gib. Gen. Hoso. Princeton. Ind.
��,�. month day yeaz hour of death � street, hospital, rural `�
w
'� Age at Death ��_Sex q��s ', Color �+�ti� o__�fai•ital Status Fiarried
- pears write �vheihe��mamed�or single
. � V
Primary cause of death given was M,yocaTdlal Snsufficlenc� •\�_
Signed by Gt enn O� 111 rt4ene��w�s�r n.� p nmRnsuille, In�
physician or coroner address
Place of burial or remo��al Maumee [fms+p89� � �____g_� __Tw.�
� name of cemeterv addresa
Dateofburiat 2/15/75 Holder F�neral Home Oxensville, Ind.
. Funeral Director address
SEAL _.
�.
,. �
f
W ��.' �y���� ' / -
Sid ied �� l ���1/ll`�
Gibson County Health Commissioner
Pr1n�9ri.� Ind. 2/1�?�__
address �� date ,
Recorded locally in book No. 9 Page \�o. 3 Filed
2/18/75
�