Death Certificate - Jackson, Kenneth Leroy Sr_10/13/1993�
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G=BSON COUNTY DEI�ARTMENT OF HEAL.TH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
R E C O R D O F D E A T H
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
KENNETH LEROY JACKSON, SR.
Died on 10/16/1992 at 11:05�`1
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 65 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Cardio Respiratory Arrest, Immediate.
Cerebral Anoxia, Immediate. Cardiomyopathy, Year.
Previous Myocardial Infarction, 1 1/2 Years
Severe Congestive Heart Failure. CVA
Signed by: Bruce C. Brink,Jr.,DO
410 N.Main
Princeton IY 47670
Place of burial Owensville Cemeterv
or removal:
Owensville IN 47665
Date of burial
Funeral home
S E ?. L
10/18/1992
Holders Funeral Home of
Gibson County, Inc.
P.O. Box 518
Owensville Iti 4766�
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;QGT 13 1993
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AUDITOR
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Sioned by �l✓: J�'�''s•'/r-�`°`�.%ytJ
Gibson Countv Health'Commissioner
Oakland City, Indiana 10/26/92
Address Date
Recorded locally :�i Fiook Vo. 12 Page Vo. 49 Filed: 10/23/1992