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Death Certificate - Miller, Bertin C_10/17/1978/ .i ... . . �• � ''�',- � . � , . n�a� ar n�A� � , ; : .. ; .. ... , � , .-� : .. . . . . .: : . . . . c�soiv yoLrrrr n�rarcTn�rrr or �nL�� ' ' ' " ..._ : : YIIIA7CLTON. LNDIANA , . _..... .... .. .... ...',, , . . : . .. ' ..: .. • . � .: : � -....,.. . .. ,..., .. . ;.. :_... i, , ..... . Tp G'�RTLFY±that our�records show',-'� ':`••' !nE�iTIN�C:=1fILLrFi .. � -.i: � .., I � TIiI5 IS . '' � _ . . .. _ : , . : .',. ; � � ,'. � :,'. ' �.' �, .. .`.�; .., t..• .: . �. �, :.... .. . ..,.. '• .. . �.F, nt7 � 1 Pbt RR �lE'� � �=�kl and' 1 tV ' 7nd. �. �'' . �0I!G�i�PM. . '%� .. � � N � O�.- �� .. ...' month �. ` .cLzy . . , vo::r..., . . . .... � pour bt dcath �.: - �.�..._ • strect, bospital� rural� �!�-J ;. ��; ... " '. i '; ; . :-.•`.::'. , .:. . . �.�+'...,. : ' ,.. Age.'at De^th 6� ' � seY �''ale _Co]or� '�.��lhlte� Fiarried -- -- , :,. . .. ' ., ycars .' � . . . • r: wriCe: whethcr mamed `or-�le '. �I . , ' . ' ', 7 . .. � � . , '•' ,.�'.... '�:',:,....,. ` f. . . Primnrycause,9f�deuth given�w�s- CoSa�'L-`�Ty 'i'hx'ombosis , " � � , _ � r: a i: � .l � °!,. --�i ' , ��.. ::�i°. .. . . � . � . _ ..; - .. ... .,. . � _ �. �� , . . ,. .. _ , , ; : , � . - . : A. A: Peters. �c�' oalclarid'�Citv•. •Znd. ; , < '; . �.. Sigtteci by; � . ' . ph}^.tieian oz coroncr � � - , addrcsn , , ,+.,�� -. � : � . .. - .: � � -� . I •� ..',i', , ^ � :. r :. ,. .'..i) � � ,.:) PL2� 'of htinal or,removal,.'�" -IIlttc] foot 'Cet*ete'r� ' PlltP Countq• Ind. . . • ., .. „ , , � ... ,. � d . . ... . _ -� 3tnmc of ccmctcry . � .. i� � � ' � `�� ' .. . ,, . ' : i ' � r. `, .. Date oftbunaL�.Zf2, fih" �L�-sl� rnnFrril � Tinr�A o� Ind. • ' . Funcral� DueeLur � i � � ' . (� �ld , -•, . • . `.. , �. . :=� . .. , . , . S��t1 �,(% ` �.�(, �l .��{'Y' . .. . .�..�,.,; . � �. . • � � SF=� U i r . '•, , : ... � .:.'� . .. ! �. � � Gibacn County Hca1W Commiasioner ...,. ''; '. y,`�' ... . ... •�.� PrincAt�n. T� ��/7a �' : A": .. . . . . , ' r�dre�y � .� . . Datc ; rr�..'.�...:'. :::.:' .- •"� . . . ,' . � . � � . ; � • . ... ., . . . Receiilel locally in bool�'No. H-50 _Pn�e No j] 1�1ed: 1?/2R/66 ., . . � o.��, . „� . .. � � . . � . �� , . • � ...,.� • ,L; , ��i'. : . .. � � . . ,. � � .. � . � , . ; • ; ' . .. � � . . . ....;� ... . _ . . . . , , .. � • . . . .. �`� .' . .._ .. .� . . . , , . . . �I .. • 4 _