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Death Certificate - Kolb, Willard_6/21/1974).. < . i � s. .tii ..t . t:^ :' ° 3t ' . � ai .t�l�� �3— ):Yl�-~ - r:. � . ...r . . .. . �� .dt _� -.qi- � .�r� : � . �1 --' C .aL�.3RECORD OF DEATH - ' . � - � i s r~ ' ' . � � , ,�:._ ' " � • � t ` " ' � .'. � u : �> �� . � �. _ GIBSOAT COUNTT DEPARTTIENT OF HEALTH ,. �r.; � x � 1�5. t '� `t ` `!� S� tt r�-- ; �� �� � ' � - � .. .PRINCETO�', IYDIANA : ' n�- t.. e � 4•' k ,i . ' . '. . ' . . . . .,-' : _ t <•� . +. f'� ' THIS IS TO CERTIFY ttiat our='records show �ILIAF3D $OLB � ,y =t ` i � � � dieci :.3 t.�� ...;� 'stt ,: :' _ , , � ..}�= ,, �ov:.6,�:i962 �t' yPia ���. . .'`• . T � , '� ,. �,=: ,_�• __:� �,; z: montn+ aay _.. '.1�3� t .}���..�' 3 . �;=,�Age at�Deattt�`—'� tc - a i+'��'f� ..f�' i } t- � � ?�.a:��j ' Yi. ' } Pnmary'cause of `�'� � Z . ' 1' 4 . �• ` R� 5! i p'��' � i� � .,i ..� �F. � , � � 3�gned by_ n1r€ : ; � k � F �t. �.}c' ;1�.3 � s" _ ., i.s ..io et. , n. d'": fi `. i y. . , �,. Y j... t raH .. � 1. + :�.'+y(� � q � � � ��X � � ., � tr f �'-•,j's i � ir.=�� 2eeorded�locally�u .. :i!,.. . :. ... ar .- i ,; chour of death- �- � �. � � ��' • stre�t, it�l �niral E� . � �i{�?���j�' tJ f � -•..�� . i. .- + . ...-,;. -� '�� �!� r . S i+ • 4�ex�gle "Color �� L.` -' niarital Status �J�+•�' Hi5 . � . . WII�'4r�-..-- . . N2'l�f�� t' ' . 3, .� . 1 - . ' . _.. - . . 1 f � � .j:: eath;given �vas � ''BTOIICho-pne{1mOAia': � � " _ � �`� -- � ��i. . .Y.� f�x.:_ .� . e�. � E_ 1. � � S it��� ' • '' ) � 1 AICCBTtye'PI D. . •, + ' T` r _r �. �' ,' ,, � `.:.ph}smian"or-coroner. �-�1AC9�.aA-r �}4�° ,� ' addtess - , t --- � .�. ,,... '�,' 'x. ,r e _. "' Decaer' • � - : - ` � emqv - - � . i:. ..name of cemetery • . ' ` : ad �ss • � "�1 i c. ���• .. �i_^; �"tZ; Y �}: v��` "! ��� ':..-.. ; neral Director.:. � - ..` , a ss'..![. .:+�' p..� � . . � j� n I'1 � F: �� -i � ..F- -:.i r � � . . � ��. ;;� a l� t-��� : � ��. :i . . ,�` 1. t .���t.. �.. � j �.`�t . t ' . ' E . l�..�.. �r�y. ' Y .. ,, � j� ` � Signed . � � � ' r% ' Gibson'County-Health'Coi I 4 rt �. �� 4..- t 'f - � , s: -����C�; .. � _L •i , - , , - , --Princeton.;`Ind -� . I. q S: .� l Y �i �� ;+i •.• .+ - address � .� : � w ; , 1 . .� .,- s , ' � .. = �. � �K , � � _,� i ._:16 • ,21 8 62,, `�; ; book��No H��O ' �page No� ' �Filed. � .� . f � .�� f� . � � . . i . . . 9 � �' �;` .:� ��: .�- R4, :� � . � � 5 �} ' � - '��_ i. . 3, f� .<. t4 �. ���� .:i d or� singlet' ;.i ,; . F J I . ; � I � r . � ••ii . ` �;. :. - .. � _ '�si S��``f f 3 � �� � � #.�s�l� . .. ,�i . .. ) O- . 1{ ♦ �. : :.`. . . ..� ,p ` 3 x f� '' ioner . Fi, , =:' .Y. � ( ,�.a �� = i. �:'' ;..: