Death Certificate - Hosmer, James Carl_3/22/1994?tECGFcD OF DEATH
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,I�AR 22 .lggq
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AUDITOR��
GIBSON COUNTY DEP_9R.TlIENT OF HEALTH
PRINCETON, INDIANa
THIS IS TO CERTIFY, that our records show .1n�tiFC t'n ,;. xn5�+_E� ______��e�
����_ __ at' 28L- Maple St. , Owensville, IN ____
month day year hour of death street, hospital, rural
Age at Death 79 Sesmale Color White�qarital Status—married
Y�� �vrite whecher married or single
Primary cause of death e ven tva�. �'nnqastivp Haart Fa; i t�-P __
Signed bc r:-n_ n;rkancnn n_�_ nw n vi11e Iv
physician or coroner address
Place of burial or removal Mai�mee Cemeterv Ocaensville, Z`i
name of cemetery address
Daie of burial_7-28-8? Holder' s Funeral Home Ocaensville, IN
F�neral Director address
SE:1L
G� ��:-n, �° �� . �,v
Gibson County Health Commissioner
_C).ak1a^a r-y�_,� 2\ 1-27-85
address date
.°.ecorded locall�� in book No. 1 � Page No. 1 Z 6 Filed : �- 3 0- 8 4