Death Certificate - Kerney, William J_7/10/1990RECORD OF DEATH � �'
� ' i. ,
GIBS�COUNTY DEPARTIIIENT OF HEALT�
.� � ' . PRINCETON, INDIANA
TI�IS IS TO CERTIFY, that our records sliow '�'jILLI�i'rf J• 1{�RId�Y died
5�3o/71 � at 5:25Pj+� RR Buckskin, Ii7d.'
month day pear .. hour of death street, hospital, rural '
Age at Deatli5� Sex ���' Color 4'�h• nfarital Status P+larried
years � write whether married or eingle
Primary cause of death given was Coronar.y occlusion
Signed by Bruce Brink, DO Princeton, Ind.
physician or coroner :' .address . �
Place of burial or remocal Decker RR Patoka, Ind.
. name of cemetery address �
Date of burial���71 ICPndal i Pri nceton, 7nd . '
.�, . F'uneral Director . _ address
SEAL
Gr> ���� � � �.� ,
Signed
Gibaon County Health C missioner
Oalcland City, In�1. 8/1�/79
� addresa aace
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Recorded ]ocally in book No. 1;-Sz Page No. i5 Filed: 6� � 71
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