Death Certificate - Kissel, Clarence Christopher_12/8/1975RECORD OF DEATH �
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GIBSON COUI�'Tl DEPARTII2ENT OF HEALTH
PRIVCETON,INDI�\'A
THIS IS TO CERTIFY, that our records sho�v CL,.AAENCE CAR25TOPHF.R KTSRF,T, died
Jan. 21, 1964
month day } eaz
8AM FtP. #2 Princeton, Ind.
hour of death street, hospital, rural
Age at Death 53 Sex Male Color Wh1 tP �Zarital Status Narried
years write �chether married or single
Primary cause of death given wa� Uremia polsbnin¢
Signed by Panl F. _ Pa aA �]l,� �
h �ician or coroner a ress �
P S-
Place of burial or remocal St. BPrn�rrlg pg � Ft. Branch, TnA.
name of cemeterc addrnss
Date of buria , � �
F�neral Director a ress
SEAL
�G�����
Signe � �'�
Gibson County Health Co issioner
Oak a
address da e
i/22/64
Recorded locally in book No. A�p Page \TO.—l�.g—Filed: