Death Certificate - Lane, Virginia Maye_11/8/2001GIBSOI�OUNTY DEPARTME� OF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
VIRGINIA MAYE LANE
Died on 12/16/2000 at 12:25AM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death : 102 Years
Marital Status: Widowed
Sex: F
Color: White
Cause of death: Cardio-pulmonary failure, Old Age
Malnutrition (poor nutrition).
Signed by: Yong Cho, MD
1808 Sherman Drive
Princeton IN 47670
Place of burial Maple Hill
or removal:
Date of burial:
Funeral home:
S E A L
Princeton IN 47670
12/19/2000
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
Signed by � G• ��Ztec�/,/ ,�/j
Gibson County Health ommissioner
Princeton, Indiana 12/19/00
Address Date
Recorded locally in Book No. 13 Page No. 133 Filed: 12/19/2000