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Death Certificate - Kolb, Janice P_11/2/1977-J, .: . . �. � ,, � . . �, . � .. . - r - ; , � , � ' �. � �: �� ' ; � . , �� _' i ,, ' � 4 I ' �a ti < : � t; �. ts � i �} - � _ ,� 3 �{ � - + ! �l �: Si 'jt � t� , ' ,� �: t >>-'!t [ i% . ii � � z 11{ FI . RECORD OF DEATH 1 } '�. T� 3?.--- ! .tt.� E� �?� �� '1 �i =�7 �i . 3f� �`�i� {, : S, „_ } t �''_�S +� }F ;� ART�fE �t� f �. � �1 ' t� �' � ��.� _ }1" 7' � '1 -f .,�j� S} GIBSON �COUNTY DEP NT OF HEALTH �� ( ��i� } `��} -� Y '� �� _ is �.i� . i. "�+ 1u.`..�r��..��}'.` f�3:, �.� +� �i.. Pnr� m� C .t r-D - • � e{ . �� 2. �F t�..2 ��.�� a"'�fl.` � ..� r �� ;t �i �i �r t -� ! �1 j� �t �.1�.�� e��.. �—tt is ;,'ii 1 i- �. i it �! �i r� , �;� . °TffiS IS?TO CERTIF'P,� hat our, iecord �sh �;•' � f� �ATIICE JP.'• KOLB �,_t"-�j f��"l�'i� ��F�•}�:E ,q T� a 1 ' died > r�_"�i �- ,I ;j.°�S� .Ji ,�y j� i tfe ,i . ; � _. ; �� S i �� :. """;� �..�� '^ �i""'��3� I `{i . ' ; � , � ..� . Nov..� { YO �i!-19�1 � � �, ,�ila55A�t:Glb. �Gen. Hos Prtnceion - — P , Znd � , 3 : ��_ month. q� 1 f da9� 2 -�Y�i. i S ' ., hour of dea[h � � t �. ---'i........ ._. - t �] a.� . �:� ��. _, �:...:.':... ., y .. -I . =4�s�ee� Lospital � rural . ,�� ._ . � �---' t _-'� . _'_. - �• =Age;at:Death ' 69� -4ez�'Female�-��-'•Color '�--� �•4lhtte 3.• � -fMy�.rlq�t � �'z s . � � ye?T9 � ` ' ' ^ t . wnte whether married o= singlc s • ' - � � -'- L • � .�� ..�:. �� s � � t '_:} t ..i . �� i .� � .`.:ji } " 1� .. s�,; ";fL:i�.f1't..�� s� � .1 t� . Primary' cause oE death gi�en; wa� `�'erPbral = ThrnmhQal c=.z r off-"a - �� rb— : - m 1 n� 1'o�t� .-- � ._,. . _ . ' i. �= ; ;?•___ !1�':ii';'i�-^-:f�—i' ,. �c _";;_' t . { .. _"�.: .,... . ��.��: t��.._ •n_ it, :, t a�_ .7"'_ t. 1 .{.�' ��..Vi+�="'t._ � ��. .�f�� 1 i. >t .�.e ",3�. . .... ._ . .�.'_.C1!_.:_2_"• �- _ � . . .e 1C . Signed bv V1ra11 McCarty 4ID Princeton, Ind � 1'� ' s fI . . � .. phps�cian or comner ; f, � � _address ' t !' .� �}a. i �� , ,. I t _ -- i r -i � �i- � +T- � � - :�� `I ti . � � .1 Place of bunal or removal Decker - RH � Patoka, Ind -_ *�• �`, � '. .. . - ' - name of ceretery� v . ;'� -� - address.:�---� 1 �� • . ..= - .'-.;; . - - •� . . +�._�-. _� .- � . . "'-_.� _.:r- .. ._ ; � - �+ I. ::. i , � � Date.of burial 21/12/71 . �Colvin & Son � Princeton �' Ind = � ' ,�'— , -. : �� .' ' � Flineral�Dimtor . - .. - ///��d ss.= -.� j �-�°- 1 -: � - i - � _..1 � '.�//� : � --- S �.t . �, 1 i; � • + e I , SEAL`�r rl '= � + {i; S�gn - � ��L�' ,+ ' er ^ _,. _- :,��- �7.; r�J'„�j ': �� a� t ' - � ; Gib_on County Heal[h Cmnmiss�oncr :;., � ;� t �t I � ti:: �-� �^r � _��%,� _.� '.. , �r ..� �c 7PTSLICBt071�3171Q ti�'��.1 �'�'�23�%1 s � ,. i � ' . ` : � , I • -r � -'. s ! c 1 � � _.addmss. � r: ; � t V„ . - _ r � 1 . � � 1 ,-: �J.t ._.i • i ir_ -..,'�,-��. �<:� 3nDate- •�' � ` �.._,..--!t ;7';;- :' i - ':,— 4 i � ,;,Y..., .. , Record�d locall�;in�bock Vo = 8 � page No .- ti0 ._-.'Filed• --^ll/17�%1 �_:t:.j.' _' r. ` ,! -S 7 --_ - _ - _ .�. _ _ � _ ,, � , ', � � s�___. � ; il , , � + ,�111 1� _ - ��— � , ,� � � ; � o .i i` � � ��-�. - -�s ' 1__'7� 1. ,�. � ? � •� �� ,_ _ 1'_ ; ;� Ii ;,� :i� • L — t _ ;i t { � �..,.E: � ._. - - -. -._ r ._ . --- . ,_ ...., . ` _. - -� . ^- - 1� _ � i �� '� � -> > _� �t � - � $i'-f+- 1��,.._ i � , � i �i _�,�._• . � . ;:'-_„-_..r: �_t� �,,, �1' .� . ' ' _ .. _ _ .. _ . !� ..