Death Certificate - Humphreys, Samuel R_12/13/1990G= B S O N
� �
COUNTY DEPARTMENT
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
R E C O R D O F D E A T H '.
OF HEALTH
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
SAMUEL R. HUMPHREYS
Died on 11/15/1990 at 6:05 P.M.
Gibson General Hospital
1808 Sherman Dr.
Princeton IN 47670
Age at death: 89 Sex: M Color: White Marital Status: Married
�Cause of death: Acute Congestive Heart Failure ( few hours)
U.T.I. ( Staph Auerus)
Signed by:
William R. Wells, MD
510 N.Main St.�
Princeton IN 47670
Place of.burial Oak Hill Cemetery
or removal:
°atek3 ?N 47666
Date of burial: 11/17/1990
Funeral home:
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
Signed by ✓i�.��_C' 'ti`L"��-- ,/e+•�'
Gibson County Healt ommissioner
S E A L
Recorded locally in Book No
Oakland Citv Indiana 11/30/90
Address Date
11 Page tio
131 Filed: 11/30/1990