Death Certificate - Hurst, Jerry T_8/9/2001n
GIBSON C�UNTY DEPARTMEN'�F HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH �Oc�-DD.�a3"�
THZS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
JERRY T. HIIRST
Died on 07/19/2001 at S:lOPM
Gibson General Hospital
1808 Sherman Drive
• Princeton IN 47670
Age at death . 70 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Respiratory Failure, Few Hours.
Advanced Lung Cancer, I Year.
Congestive Heart Failure.
Signed by:
Place of burial
or removal:
Date of burial:
Funeral home:
S E A L
Rameshbhai P. Patel, NID
105 N. 2nd Ave.
Princeton IN 47670
I.O.O.F.
Francisco IN 47649
07/23/2001
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
Signed by � G ��- --' '% '��
Gi son County Hea t Commissioner
Princeton Indiana 07/27/O1
A ress Date
Recorded locally in Book No. 14 Page No. 17 Filed: 07/27/2001