Death Certificate - Jewell, Jack_9/20/2002\
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• Pri�c�to�, Indiana ��6�
812-385-3831
REOORD OF DEATH
THI6 I6 TO CBRTIPY
that according to the records of the Gibson Couaty Department of Health,
JACR C. JE11gLL
Died oa 03/03/1996 at 4:07AM
� Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Aqe at death . 58 years Sex: M
Marital Status: Married Color: White
Cause of death: Cardio Pulmonary Arrest
Signed by:
Place of burial
or removal:
John E. Polin, MD
3700 Bellemeade
Evansville IN 47714
Memorial Gardens
Owensboro KY
Date of burial: 03/07/1996
Funeral home:
S E A L
Stodghill Funeral Home, INC
304 W. Locust St;eet-
Ft. Branch ZN 47648
� Signed by ���"t7G'• �`�'G'�`'l!
Gibson County He th Commissioner
Recorded locally in Book No. 13
y
Oakland City Indiana 03/13/96
Address Date
Page No. 5 Filed: 03/13/1996