Death Certificate - Martin, Verna Katherine_9/5/1978RECORD OF DEATH � �
GIBSOAT COUNTY DEPART➢4ENT OF HEALTH
PRINCETON, INDIAN�+.
THIS IS TO CERTIF'P, that our records show VERNA KATHERINE MARTIN
7/1/76 at 5�5�PM Gib. Gen.Hosp Princei�n, Ind.
month day year hour of death street, hospital, rural
Age at Death �7 Se�c Fg. Color wh.nfarital Status Married
years write �vhether married or single
Primary cause of death given was Pneumonia. left lun�
Signed by James F. Peck, M.D
physician or coroner
Place of Uurial or
Shiloh
name of cemetery
inceton, Ind.
address
Hazleton, Ind.
address
Date of burial 7/3/76 Holder Funeral Home Owensville, Ind.
F�neral Director address
SEAL
Gv ��� �° � < �,�
ssgaea
Gibson County Health Com �ssioner
Oakland City, Ind. 7/24/%8
address date
Recorded locally in Uook No. 9 page No. 28 �led: 7�9��6