Death Certificate - Ivy, Mont C_1/4/1972RECORD OF DEATH •
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GIBSON COUNTI DEPARTJiE\T OF HEALTH
' PRIVCETO\, I\DIA\a
i .
TfiIS IS TO CERTIFY, �that our records sho�s MONT C. IVY _ �1e�
, . .
Nov. 16! 1971 at 12s1$PM Gib. Gen. Hosp. Princeton, Ind.
month dag qear � hour of death street, hospital, rural
Age at Death �3 Ses 14a1e_Color WhitE Married
years �crite �chether married or single
Primaiy cause of death a cen wa; Co�e�t ve i'lQBI'_�f�1L1Te
Signed by �gvid Lindauer, P'ID Princeton, Ind.
physician or coroner � addmss ,
Place of burial or removal Whlte Church PTinceton. Ind.
, name of cereter}- . address ,
Date of
Flineral Directot
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_ ; SEAL : -
, (
. � �ii
Ind.
Gibson
Princeton, Ind. 11/26/71
address Date
Recoi•ded locally in book'No. 8 page No. 41 F���]: 11/26/71