Death Certificate - Jones, Herschel_5/21/1990RECORD OF DEATH � �
GIBSON COUNTY DEPARTTIENT OF HEALTH
. PRIVCETON, INDIA\A
THIS IS TO CERTIF�, that our records show HERSCHEL JONES died
Auaust 14, 1987 at 9;37 P.M. Wirth Osteopathic Hospital Oakland City In
month dny qenr hour o( dcoth street, hospital, rvrnl �
Age at DeattL 64 geaNale Color �dhite �4arital Staws Dfarried �
years write whether merried or single
Primary cause of death given was Cor Pulmonale (acute) , Chronic Obstructive Pulmo-�arv
Disease (years), Pneumoconiosis, Diabetes and Arteriosclerosis.
Sienedby H• A• Peters, D.O. Oakland Citv In
physician or coroner address
Placeoiburialorremo�al Providence Francisco, In.
name o[ cemetery eddress
Dateofburiat auat�st__17, 1987 Lamb Hedaes & Basham Alem Chapel Oakland ci�v In.
Funerel Director address
SGAL
Signed ���/���9�> °��k:•��%
Gibson County Health C issioner
Oakland City, In. august 19, 1987
nddress date
Recorded locally in book No. 11 Page A'o. 49 Filed: August 19 , 1987
a
e