Death Certificate - Loveless, Roy H_11/16/1977C
RECORD OF DE aTH
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GIBSON COUNTY DEP_ARTDIEI�TT OF HEALTH
PRINCETON, IA'DIANA � , � � � .
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THIS IS TO CERTIF'P, that our records show ROY H. LOVEI,ESS d�� '•
10/5/71 at 9PM Gibson General Hosp. Princeton, Indiana
month day qear hovr of death street, hospital, rural. , ��
Age at Death 6� GexMale � Colorti�ite ;�qarital Status Married
- y�� write whecher married or single
Primary cause of death given �vas _ Coronarv O�clusion
_ Artar;n�r�aro �� heart disease
Signed by Wm. R. Wells M.D. Princeton, Indiana
. � phcsician or coroner address � .
Place of burial or remova? nAa�yl a gi l l Pri n�aton, Tndi ana -
name of cemetery addrnss � �
Date of burial (:o1vi n and Son Princeton Indimna �
, . . , , Funeral Director address ' . � -.
' SEAL
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Signed /
Gibson County Health Co ' ioner � �';•• ". °
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(laklanri ('itai�� Tnd .;F 1 i :ll�l(/77 .
. . , . . . address . �� ..,�:.
Recorded locally in book No. $ Page No. 38 Filed: 10 l71 � .\� �
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