Death Certificate - Klusmeier, Benjamin F_9/26/1983�F,!pIZD OF llE:1TH • �
G113SON COUNTT llI:PAI:'fD11.A'T OF HPALTH
rai*acr:TOx, irn�nn�n
'PI11$ ]S TO CERTIF], that our records shoK� BENJAMIN F. KLUSMEIER died
�1�83 at 7:25AM _Gib_Gen. Hosp. Princeton, Ind.
month day year hour of death strcet, hospital, rural
� 80 M. S4h. Married
Age at Death_ _Sex Color \farital Status
}'exrs u•rite ti•hether married or single
Primar}- aause of deain given �eas Congestive heart failure
Signed b�•
Place'of burial or
Date of bm•ial_
' n
SEAL,.
�ert K. Foley, M.D.
physician or cnroner
St. Paul's
; al _
� name of cemeten
9/19/83 Stodg
Fvneral Direttor
Princeton, Ind.
addmss
Ft. Branch, Ind.
• address
1 Ft. Branch, Ind.
address
�����,��
ed
Gibson County Health Commissioner
Oakland Citv, Ind. 9/21/83
address date
Recorded loc;alh• in book No. 1 � Page I�To. 100 �tiled : 9/ 21 / 8 3