Death Certificate - Hart, Otis H_11/16/1987� i
RECORD OF DEATH
GII3SON COUNTI' DEf'ARTMGN7' 01� HGALTH j.. _:. '.
� I'RINCIi'I'ON. INDIANA i
THIS IS TO CERTIFY, that our �ecords show UTIS H. HART died I
2 21 52 �� 1:15 A.M. Patoka Patoka In. I�
monlh dny ycnr hnur u( denth ntrr.el.. hocpitnl. rurnl � �
I
Age nt DenLh 60 Sex Male Color WhitdVlnrienl Stnt.us Mdrri.ed �
ycnrs � wri�c whether murried or Fingle i
Yrimory cause of denth given wns COronary OCClusion
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Signedby H.H. Alexander M.D. Princeton In.
physicinn or coroner �ddress
Plnce of burinl or removal Patoka Cemetery Patoka , In.
. ' nnmr of crmri�•ry nddrevx
Unceofburint February 23, ].952 Col.vin Funeral Flome Pr.inceton, In.
. Funcrul Diror.tor nddrexn
V� ,l
�%ti ta-ni�"-��e,x,�;
SEAL Signed (f
f.,iLson County hlmJth Commixsioner
Oakland City, In. 11-13-87
uddrevs do�
Recorded locnlly in book No_ H-96 Page No. 255 �iled: ?_-23-52
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