Death Certificate - Lewis, Olive Mae_5/22/1984RECORD OF DEATH � �
GIBSOAT COUNTY DEPART➢SENT OF HEALTH � '
PRINCETO\�, INDIANA � -
THIS IS TO CERTIF`Y, that our records show OLIVE NiAE LEWIS
11�22�71 at 2PM RR Francisco, Ind.
month day year hour of death street, hospital, rural � -
Age at Death 5� Sex� Fe• Color wh' Mai�tal Status M�
years write whether married or single
Primary cause of death given was Coronary Thrombosis
Signed by
Robert D. Kendall, Coroner Princeton, Ind.
physician or coroner patok�aaress
Place of burial or removal Decker RR Pat�a, Ind.
name of cemetery� address
11/24/71 Kendall Princeton, Ind.
Date of burial
F�neml Director address
SEAL
�J�� �° � �.�
Signed
Gibson County Aealth Commi ioner
Oakland City, Ind. 11_/24/81
address date
Recorded locally.in book No. H- 51 Page No. 20 Filed: 12/ 1/ I1