Death Certificate - Hurst, Jerry T_11/1/2001T�°'�' .
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GIBSON C�NTY DEPARTMEN'I�F HEALTH
' • 800 S. Prince St.
�� �' Princeton, Indiana 47670
812-385-3831
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RECORD OF DEATH
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THIS`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:iOPM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death .
Marital Sta£us:
70 Years
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, MD
105 N. 2nd Ave.
Princeton IN 47670
I.O.O.F.
Francisco ZN 47649
07/23/2001
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
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Signed by
Gibson County Hea t Commissioner
Recorded locally in Book No, 1?
Princeton, Indiana 07/27/O1
A dress Date
Page No. 17 Filed: 07/27/2001