Death Certificate - Kirk, Clarence E_12/11/1992�
G Z B S O N
• �
C O U N T Y D E P A R T M E N T
800 S. Prince St.
Princeton, Indiana 47670 �
812-385-3831
RE CORD OF DE ATH
OF HE ALTH
7HIS IS TO CERTIFY
that according to the records of the 6ibson Coanty Department of Health,
CLARENCE E. KIRK
Died on 07/22/1991. at 9:34pm
6ibson General Hospital
' 1808 Sherman Drive
Princeton IN 47670
I Aqe at death: 80 Sex: M Color: White Narital Statas: Married
Cause of death: Sudden Death, Massive MI or Pulmonary Embolism
Fracture of RT hip and acetabulum and RT elbow
from accident 4/30/1991.
Siqned by: Yong Cho, MD
1808 Sherman Drive
Princeton IN 47670
Place of burial Archer Cemetery
or removal:
Princeton IN 47670
Date of burial: 07/25/1991
Faneral hane: Colvin Funeral Home, Inc.
:7�i7�
425 N. Main St.
Princeton IN 47670
Signed by _� "'�.�'rl!�"'�" .A�J
Gibson County Health orrmissioner
Oakland City� Indiana 08/06/91
Address Date
Recorded locally in Book No. 12 Page No. 16 Filed: OS/06/1991
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