Death Certificate - Lewis, Howard F_12/14/1976� .:,
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RECORD OF DEATH - � _ ^
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' GIBSON COUtiTY DEPART�IE\TT OF HEALTH , �.
PRINCETON, INDI:�NA � - -' . �
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THIS IS TO CERTIFl, tliat our records sliow vnvrq�r c� . r�;.,Tq died
�. 11/iR�1Q7Fi at K�'i!1�r,� pR� r��.P R� n�.t.�6P�B^, �t�ci- •
�� month day year hour of death street, hospital, rural .
Age at Death 5q Ses �•��l P; Color���iye_\Iarital Status Piarried
years � «z�ite �chether married or single
Primary cause of deatli given �cas Arute mvo�ar�?;al i�°arrt�nr
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$lf,:.� �.'.� ?TUCE Br.i.,k, nn A�l.nnotn'�`�T"'�- -___'.
� ph}�sician or coroner address
Place of burial or i•emoval r.:a nl a�:; i i Frinceton, Inci .
name of cemetery• address
Date of burial �-� �?i��� .^.ol vi n �� .Snn pr; r�?r� , '
Ftineral Direcior address - � . _ •
SEAL
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l�t/ �i�/�s�%`LL C� . ' . � _ .
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Signed /
Gibson County Health Com ssioner � �
_0=�klsn�l Citv, In�l. �.2,/1�/7S
address date�
Recorded locallv in book No. �-K� Page ATO.—_2�Filed: ��/1 �/?�,
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