Death Certificate - Jaquema I, John L_3/12/1991n
BECORD OF DEATH
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GIBSON COUNTY DEPARTMENT OF HEALTH
PRINCETON, INDIANA
� - JOHN L. JA�UFtMI
THIS IS TO CERTIFY, that our records show
?_s15PT� Gib. Gen• Hosp• Princeton, Ind.
g/28/1972 &t street, hospital, rural
f d th
month daS 9ear hour o ea
Age at Death �z Sex M' Color �'—�4arital
yeare
Married
write whether married or single
Primary cause of deatli given was
Metast�tic carcinoma
t,� O�kland City, Ind.
Signed by �'7 m• E. D,y e, ada:e59
physician or coroner
i ceton Ind•
Maple Hill Pr n '
Place of burial or removnl name of cemetery address
�/�0/72 Princeton, Ind.
Date of burial Kendall Funer�l Home
F�neral Director
address
SEAL
G�� y� � / 1
s�g�ea
L(� f'�! "�>2r G . � =�`'� � '� �
Gibson County Health Co isa�oner
Oakland Citv Ind 11/10/76
8aare5s '��
Recorded lceally in book No. 8 page No. 57 Filed: 9�1
Court House Annex
Princeton, Indiana
._� Princeton, Indiana
Fage No..;;%-,> Prnpared by BENTON TITLE
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