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Death Certificate - Hoover, Allen_6/15/1977i � ��►•---�-�-E�� a �'�r .�'.by'� � C��'r:`:,-'!"''\'�� t"�?+� �?r� 1.,;.' Yl' j:�:,+v ,f4 •< ti �. ro: .;.��' :. � �•.v;�3' �.. � '�r ,.�����' . � � ' . � ; .,�, T�y�pgN YPH�N7, ,�, -�� .. ' INDIANA STATE BOARD OF HEALTH ' ' � � " M CENTINI(,AT DEA WITH� ' ' : � +��''' . EDICAL E OP TH . , v� I.ocel No. . � . <• � ,-UNFADIN6 INH .,� � .:.: . � . . . _ � -- '. .. � THI.g I$ iA � ti�' �[RMANENT INN DECEASBD—NAME n�at rmo�e� •. ...� .Lesr'a,. :. SE%,. 1. . .' DAl , W , SEE IUNDBOOII fON ALLEN � NOOVER -� ' ,Mal'e �: � - ' t � F ; INSTPUCTIONS � � �� �.�' PERMANENT O � � ' • AGE—��ST � � IINDEN 1 YCwR unO[n i'OwV '- OAIk OF BI0.1H RACE I pcMnD.�� �i 1�; � '� .. . f.•• � • OIRTN��•IYE/�P91r.. MOO. OAYO . IIOVR9 MIN. IMONTII.O/�\.l �l L�1' a��,�o. + ��T_ _ .. White sa. � � — ,:n, s�. � e. =F.,a� ii iv a��,� �� � CIIY, TOWN, 00. IOCALION OF'OEA1H �� iNeio6qix.Llwiie HOSPIUL 00.AINER Ii:SIIIUIiON—n'Am� �iv �� g�y��agtiq�pQlnUw � ,.. . � �' ' �sreaY'��gonnoi Gibson General; � .-� W ' Princeton ,�. ,e. ��' ' ' � 7 p r. � DECEASED ]b.- ` J 9A1E OF B10.1H pr Hor iN o.n.w., CIiIZEN OF WHAT COUNLRY .. .OMARRIED��EVER MARR�ED 0 SURVIVUa . . A • • w 7' � NwMCCOl1NTl1V1 . . � �'� � �U6U�1P691OENCE B,_ Indiana _ � o. USA �w,00weo ❑ DIVOR�ED ❑ II. ' p • ' �� wM[Ae o[c¢weco ��AL SECU0.1tY NUMBER USUAI OCCUPAiION �orve nir�o or wonn oone ouniNa KIND OF &1SINESS1��O LIVEO. R �E�TM � MOST<�I WOI�RIHO LIIC. LVEN II PETII�CDI �W ' Y. � '� OCCUPRED.IN �'Jj�. �.! ' . � . .. ; �,.a.�.�,�o�.o�„E ,v. __ . ,�a. �C.&.E.I. Railwa ' L` � � ;'n¢sioeMCeocrox[ RESIOENCE—SiA1E CWN7Y CIiY, TOWN OR LOCAIION moioeurrurirn C � � :'•'/�DYIl310N. 16VCCIVY��lgRN01 � ' ot N 7 Gibson Princeton ��d :,� `-� :... D`:, � v, � ifndiana i.e. _� u�. 4„' Q�j ��j ��, SiREEI ANDp NUMBER . I�p. ' W0.5 �ECEISEO EVER IN U. 5. A0.MED 'OCCI � � � �� 7 J� S. S tOU C , IYe�, ra, o� vnknown� III yer, qiv� war or dah� d •• .' E---- ' � < �.�. _ No _. � ' ' (L �;,C ��• FAiMER—NAME Ii�OT •IOOL[ L�S* MOIHE0.—MAIDEN lUME, Flql � • i � Mary HooJe.r.-; F ° Q� PARENTS Clarence Hoover ,,, . ,� +''�. .'�' ... � � 5 ,. '�' J � 7 " 15. ' REIAIIONSMIP MAIIING A�OQESS lain[I �' � �' � INiORMANi—NAME ' Pi,lnCe� n G.;_ -_--'� a vW,S . Wlfe.:._ � • � w �., . ,,,. Margaret Hcover i „c. ��� ,; •,:" . �1^z = A U 7 U. . _ V�41 1. ' ' OE�IH WAS.UWED BY� I �ENiER ONLY ONE UUSE GER IINE FOR (a�, Ib�, AND IQ�� +1•. , ..,i • . � � .7 W .7,�' � IB. iwM[m �oume[ `yy/ � � � � ! /�"n` " ,.( � li� � /„ � � � "�'�� ' lal , •, '^�' •^• -. COND�TIONB IF6NV. � DU[TO.Q��"j� �NCE01 � � � � '1' _ 1```� WNICMOM1ViflISETO j"�I� ea�`.._, i�reoiet[cnuoa.r��. � Ibl"��/L2�i� : ,. ..aa / C , , ST/�TINGTMEVNOEN. �•-..�OUiT0.�A0/�CONCOUENC80I: I�,�� �`�� J LVInO CnUBE LA9T �// ./) R�. }�• 1 V ,� . �. . �(� ��� II r . .. : . . . C11U51 , . . ppqi11.07MEY5�GNIRCANiWNIION'conomo c ixmutiNO�ooeerr�evnorneui[o�o�a.ASC�.`}` Z .� �Y� � OIV[NIN��RT�IU � .� . .�1�.j�t �I �� v _ - l. �.V1.1 y"� �.� � � �, � �..A'. . Q . .. . ' ' ' Y . . I � �� � '' - �. .' °~ i. ���.�`"" • �� � ^i� ... pAIE 6 iIME OF DEAiN .woNiw �. - owv , vun woun DAIE SIGNED . �..'+'+c�T��, �� `'?' . �,�' S � 9_10-1977 : 4.10A 6-11-197.7F� _ 6... �� m. xto. .p :. -' �. smnnw �u .��.-„4 _ .' ` . . �. YMYSICIAN'S NAME ITY�[ O� �Pit�il '. I�STIN �TTEND�MC[ RTE. �'`'' e%'� '� M.o. ,,,. Bruce Brihk DO' � 'I�1.•'�1C� ' � ' �p .. MAIIING.�DDNESi—'MYSICIAN ' . "... . crtv o ow �TI�C[T OI� P.I.D. NO 'L��� � � �Princeton;Inc �4,�i� ;T. � o..o... 2 za 410 N.Main,S�reet, �:. . . !] � . Ij pI1RIAl.. EMATI . R MOV, l' [FMI:TERY. CREMAiORY. FUNER L HOM! lOUT10N -i C ..� -a . ' ��. .+.{.. u�acim . � � � � ry � �atC13IIa'C' � -' z , , }..: a. z, � - � ;� ' Burial.' � , z.b. Montgome • a �. � r . ,; , �,. ay� A T. �. • . • Dieyoaitioo Permit �� ; �� oisrOf�7�OM '=O�T� ��OMiw o�Y �'[��� � V FUNEML IqME—NAME AND.ADDRE55 ���a[ROn e v 0.�H� �„o� -.� � z Q�� ,�^ � 6 12 1977� � „�.,'• COLVIN & SON Princetor r 47' � '� . Y. �m NGl1H OfFCEN—SIGNAIU0.F ��: � z� :a. � Piovieional : � i; . •< � �'. . • r S�, � '��.: r', •, Gx � "-+ . _ . ?. . r F y � ' CertiBeate �a. a �9 '+�' .t � '�`a w. . a'+if `. � � '. ` . r , - �n''t � . "�' �p .Yes .. p No : <' W y � ,,. ' � a ._zse . ., 1 � �` i am �. ,�� . , '°e �7'r� . ' - - ',seHOe=ooa•; 'r.:G.. .w . N .. . . � . �. n9„�. . 47 . 4..'m C. 'i ,:ra �a '.� • �•w'#`a ��'• i. � . � ~, . . . '� . . ,..y .. .. c .. � • , _" _—_ _I"_ _ _ . _ _' _ __ . � ' � ,....�,.. ,. . 6-10-1977° •'�,.�: CWNIY OF DEAIN .: _ �- .cy,: 95 '` GiDson���;� OT IN [IT11fM: OIY{ OT1E[T /.MDjN41 �ospital , .:, .... SPOUSE, pr,wne_mre �u.iow wi r'' •:> '