Death Certificate - Johnson, Rose M_9/14/1998GIBS(1V CO HEALTH Fax�l-812-386-8027 Sep 14 '98 15�27 P.O1/O1
'� °Ck''" GIBSON CI�TNTY DEPAR'1'M�;N'1' c:�ri�.�,�1�t�
800 6: Prince St. �
� PriACeton, Indiana 4767o
:i�%I iCF rclt Dp5 DUB9 -tic� 812-385-3831
RECORD OF DEATH
THI6 IS TO CSRTZFY
that according to the records of the Gibeon County Department of Health,
ROSB'M JOHN80N
Died on Ofi/16/1986 at 11:45p
Gibeon Qeneral Hoepital
1808 Shennaii Driva
Princeton IN 47670
age at death . 47 Yeara
Marital Statue: Married
6ex: F
Color: iVhite
Cause of death: Cardiopulmonaxy arreet, Severe Diffuse Atheroeclerotic,
Cardiovascular diaeaee
6lgned by: Michael Kilpatrick, M.D.
1808 Shexman Drive
Princeton IN 47670
Place of burial Maumee
or removal:
Oweneville IN 47665
Dnte Of burial: 06/19/1986
Puneral home:
S E A L
Holder'e
319 S. Main
Or.reneville IN 47665
Signed by W �?'/ �1 G�. �+�hs��'�
Gibeon County Hea -Couoniesioner
Oakland City, Indiana 09/14/98
Addreee Date
Recorded locally in Hook No. 11 Page No. 15 Filed: 07/O1/19B6