Death Certificate - Kemper, Herman T_6/26/1979•� .
' I 1
� RECOItI) �1F U1::�'I'li
a
t
•� i
'
, : � �
�
�� ; �
A
GlI3SON COUNTY DEP:�PT�II?NT OF }IEALT2I
PitINCk;1'ON, INUI.INA
T1IIS IS TO CGI�TIFY, that our records sliow 1�RI'.AtJ T. K�iiPER d��
6/�/1966 af SOA1�] 802 E. Ohio Prnceton, Ind.
month dny ycnr hour of dcath etrect, hospital, rural
Age at De;�th b1 Se�c r�' Color '�' �Sarital Status M•
yeare write whether married or ainqle
Primary csuse of delth given was Coronary occlusion
Signed by Orville �;. Graves, i�:.J. _ Princeton. Ind. ��J
. phyeician or coroner address
Place of burial or removal Maple Hill Princeton, Ind.
nnme o[ cemetery address
Date of burial 6/10/66 Kendall Princeton, Ind.
Ftineral Dimctor address
. I
�������� ��� .
SEAL Signed
Cibson County Health Commissioner
Oakland City, Ind. 6/2G/79
addreas
dntc
, Recorded locally in book No. � page No. 136 F;tea: b/lo/66
} �Y
I ��
u