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Death Certificate - Maxey, Haskell_3/30/1978-.... _ . . T ... _ _q _ _ .,. � � :. > RECORD OF DEATH - GIBSUIV COUI�'TY D�PARTniENT OF HEALTii� �� PRINCETON, INDIANA - ' " ,' . � . TH15 IS TO C�RTIFY, that oui• records show HASIfELL UNION MAXEY , a��' '� 11/29/1475 at 5PM Gib. Gen.Hosp. Prince+on, Ind. " , `�-�month dag year � hour of death street, hospital, rural �- .�� ' � 78 D9ale White P+Iarried- -f ,_ Age��at Death Se� Color Diarital Statuc '- years � � write whether maaied or-single Primary cause of death given �oas Oat Cell Carcinoma of I,ung � � S�gned by William R. Wells, M.D. . Princeton, Ind. ' _ � � - . . physician� or coroner � � address - � � : � - 't ' Mont omer 0 kland Cit Ind. �� Place of burial or removal g. y. a y� '� � � name of cemeter5• address � � � � ' . `t Datc of burial 12/3/75 I,amb-Hedges Memorial Chapel Oakland City, Ind. • . . _ ,,.. _ _ _ _ . . _ _ _ _ .. . _. . .. . 4. ' � � � Btineral Director ' � �� address � � - ' � ' � , �} .,,� � � � �y� . SEAL Sign vv G" �'l�=�G. . , Gibson County�Henith Co issioner� - � - ', �-��. Oakland Citv. Ind. _ :'if30/78 ._ � � address � .date� Recorded locally in boolc ATO... 9 Page, Na _, 18 Filed: 12 1�/75 ' , . _ _ .. � s �- ,-- .—. - —_-- ...... __. -. ' . . �/ - :- - - -' - ' '." " , , 1 , - - ' - . . ..� . _ . - . . . , 5 . " . . . , �. . . . •.� � � 1 . . . . . - • 1 . , • _.. •- . . ^ - . � ' ' .' ' � .. . ' '' ' •.. _ ,:.• . ->._,_... . . �.. . . '' . "-- - . , �.• ; . ... . � . � ' - � ... ' ' . � ' . r'i;;. . � .��e,. � � :. � . :. ' � . . � - ' �� * - . • , • . _ ' �. . .