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Death Certificate - Jeffrey, Jessie_5/4/1973j , ' . ` . 4�•. . "t � .�. 1 . . r � �, . (_ . • .j.� . . lr f . . r � . .�. r v RECORD OFrDE 4TH , � _ , � � ,' : � _, . 1 r � � � � i.. .. � ,: f ,' -� ;. i � - .r. --! GIBSON COti\TY=DEP.IRT�IENT OF' HEtTL1'H " i ' - � _ � � � ° _ PRI\CETOT,°I\DI:4\A � ` - � i ' ` - ,..,. � � � 't: ,i. -'„� .- � : : . -� � � ..�:.' - -., �. - . } � �' � � '... .. t ; J � Y '_ ,:_ THIS� IS TO' CERTIFY,';thati om; recordssho« �•- _�� JESS IE . JEFFfiEY .•i ��+ ' diedHi � , �. _ - . - .. . . 9 ril.. � � 16�: -1'� .. � . .:. :' . _. ' �. :� : P '. . ,- . . 973 -'at3AM = �l.i W.. Walnut PT__1_nG_e�osa,- Ind: � . � � � month� j �'-�day � ear � - ; ��houi of death r - , � � = street, .ho=_pital -ivral t . n �' ( • .i, . ..�- � �i� :.... ' A�e at Death '75 ��Ser Femal� ' � F ,� _ _ . ~ i- _ e ' Color , _tt►it e '_�:.3g�e: . : a �. } eais � ; . .. � � .' _ _ ; � write «hether' married or�cingle : � � ' ., 1 :t ' - -�! ' _ '�' ',�: :' � �.:J , . , . Priiriai� cause.of,death:given w�as 'AcUEe MYOCaTd1a,l-Thrombosls�=� ; � �' _,-. _�� - _ - •r. _ ;i;- , `_ .. . :- , - , ; • : . . . .. � � � ._ , -1 , _ � � Ei S�gnecl by i?' S. .M6Elroy;�'M.� =' psinceto�,��c'�:� - - . �' , ;phys�cian �or coroner � � : _ � • � address � � t � � � ' . � . . . i. .t ."�.�i ..., _ _ . . ' - ; ,Place of burial or iemoval "I A:O:F,_PZ1IICeton,_Tnd: - - - - _ �. � ,� i -- ` � � � name of cemeten . '= � � � � ' �- � ! � . :.. address � ` ` 1� ;`, �i �.�` 1 I1. �� .,1�. . F � �. t.� ' .. �'..i.. :1.' � �� t � � �' �t�. • Date�of bm�at�4�18�73 - .Colvin:&• Son ,= Prin6eton-, '.7nd.,t �-, - - � .� �.'. , ij ,-�, Funeral Dirnetor _ � ..':�� -� '`"' �. -addrn �• � .- '1=�':. ; _ � , • � . �_SEAL1,'� � "- � � _ �° �:�S�gne '`- � , - — ' - �_�,� _ • 'X �. .q', � _ t:_` .• •�,� ibs r � _. _ oner..�. � .�•:, i .� � � `4 �� .i: .�� -�:..:� _: -.--� _ . . _._, � � ' .�s;: '•. '� Princeton;. Ind. I� /-23•.," f"", ' `- � ' ' . 5/3 - � �, ' `� 'i "- : : �,�'�� .addmss '':;�� ' ' ��; .�._� Date. � �Reco JdedYlocall�t �n�book_A'o $�� ,. page I�TO.i: 74�"-' F'iledT_�/1�'� -- m', Yi ... .\Yii:.. 5,.1 .. � �. �i. ;' .[ ' :- . 'L. . _ . . ;� _ •_ . ,' : , �' ��;�� 1[� t t ' � � ! .��1 � 3 � �.�� . . �i'.''' . ' f� � 'f .i.._ .� ' � _ :i. - - ��. �'7 � ' ' . . '� ` .�� _ i - - t , . .. :!. ' ' ' ' ' ' , ' ' �. .. " 'r ' . ... .. :.. ._. .�.1. .�.. _ . ..' " ". .i:� _ _.'..__' ."_'..... �_ '... ._.. .. . . . ._�. _.