Death Certificate - McIntire, Octavia_4/1/1985f�ECORll OF DEATH � �
GIB3Giv COIJNTY DEPARTIV[ENT OF HEALTH
YRINCETON,INDIANA
['HIS IS'f0 GERT[FY, that our records show OCTAVZA McINTIRE died
4�10_/83 at 4:45AM Gib. Gen. Hosp. Princeton Ind
manth day year hour of death atreet, haepital, rural
\ge at Dexlh $9 Sex Female Cp�or WhiteMarital Status Widowed
years write whether married or eingle
'rima�y cause of death given �vas_ Cachexia
iigned by__ Hassan Rayes, M.D.
physician or coroner
'la:e of }�ur.al or removal Durham
� name af cemetery
)ate of burial 4/12/83 Stodghill
Flu�eral D'uector
SEAL
Princeton, Ind.
addreas
Ft. Branch, Ind.
address
Ft. Branch, Ind.
address
, i
� L� �`��"?� G. ��., sy,11
�">
Gi6son County Health Commis.voner - • -
Oakland City, I�nd. 3/21%$5
addresa � ., date
:ecorded locally in book No. 1 � Page No. 91 F;��: 4/ 2 8/ 8 3
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