Death Certificate - Mason, Cletis_1/20/1975�
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PETERSBURG,INDIANA
I:ECORD OF
DC:1Tt�
THIS IS TO CERTIF'Y, that our record5 sno« Welza btason
__,I�nuar 8 1975 Holiday Hone, Petersbu.rg, Indiana
, ai _
mon[h . day year huur street, hospital or rural
71 male v�hite married
age sex color married or single
ACUte cardiac dilitation
Pnmary cause of death given ���as
Sa��a b�, Dr. Joseph W. ELbert, D.O. _ Petersburg, :tndana
Physician or Coroner addresa
place of burial
1-10-75
date o! burial
Recorded local]}� in book \o. 13�
Filingdate 1-1�-75
Petersburg, Indiana
died
Oakland City. Indiana
cemetery• addres-, • �
Lamb hedges Memorial Chapel, Oakland City, Ind.
funeral director adcress .
d
.�age \o.
Date 1-13-75
Signed � � °
Pike County Hralth ommissioner