Death Certificate - Mans, Otho J_3/31/1977� RECORD OF DEATH
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,'GIBSON COUN1'Y DEPARTIIENT OF HEALTH
- PRINCETO'V IVDIANA
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-'- THIS IS TO CERTIFY", that our records show OTHO .J.. Is9ANS died
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` 'v. �'°-1/�0/1958 _ at '!5�3o:�ivi • �:-RR.�Fsancisco, Ind:
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y year �� hour of death ,•� street, hosf�ital, rural ,
''�,'.`-'' Age at Death �6� 9e:� fiale Color'�mlte Dlarital Status h�arried "'
yeare ,, write whether married or single
- - Primary cause of.death given-was - �alvular heart disease
-- Signed by R• E• 'r�leitzel, !+i.D. Princeton, Ind. •
'_ �� physiciar. or coroner address
' Plnce of burial or remo��al : orsythe Oakland City, Tnd.
� `. . c.na�me of cemetery address
. Date of burial 1�12�58 �olvin' 8; Son - Princeton, Ind.
' , � :'Faneral Director address
��_ SEAL
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Gibson County Health Commissioner
Oakland Cit:y, Ir.fl. 3/30/�� `
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Recorded locally in,book No. H-48 �� ='Page No.— 1�3Filed: 1�1��58 �
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