Death Certificate - Jones, Homer Dale_5/24/1996�--_-
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GIBSOfV COUNTY DEPARTMENT OF HEALTH
;;,• 800 S. Prince St:
.- Princeton, Indiana 476�
.. 812-385-3831
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RECORD�OF DEATH.:
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THIS IS TO CERTZFY • -' y
that according to the records of the•Gibson�Couaty Department of Health,
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HOMER DALE JONES
Died on 12/19/1994 at
Residence
609 East Water St.
Princeton IN
Aae at death . 77 Years Sex: M
Marital Status: Married Color: White
Cause of death: Respiratory Arrest, Immediate
Ventricular Fibrillation
Severe COPD, 15 years
Signed by: Bruce C. Brink, Sr., DO
410 N. Main
Princeton IN 47670
Place of burial Mt. Tabor
or removal:
Dste of burial:
Funeral home:
S � A L
Mt. Olympus IN
12/2i/1994
Co1v�n Funeral Home, Inc.
425 N. P1ain St.
Princeton IN 47670
Signed by ����G�. � �k'.�''
Gibson County Health ommissioner
Oakland City, Indiana 12/29/94
Address Date
Recorded locally in Book No. 12 Page No. 106 Filed: 12/29/1994