Death Certificate - Montgomery, Eunice_4/5/1977RECORD OF DF.ATH �
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GIESON COUNTY DEPaRT\i�NT OF IIE:�LTH �
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. . � �" FRINCETON, INDIANA - - -
THIS IS TO CERTIFY, that our records show EUNICE MOiVTGOD'�RY � died
``�' B7ar. 4, 1977 at 3� loPrl RR 3 Owensville, Ind . ,.''.
- month day pear hour o[ death street, hospital, rural - _ ,
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. Age at Death 9� Se� �e' Color y��h' \iarital Status 4tiidowed ,
pears •, �vrice whether mar`ied� or singl"e
Primary cause of death given «�as P.7edullary failure ' i j' �
, Signed. by G. 0. Dickerison; DO O�vensville, Ind. . '
phpcician or coroner . � . address .
Place of burial or,i•emo��:il Benson Owensville; :Ind.
. ' � � � name of cemetery � ' .. ' , � iaddress
Date of burill 3�6�77 Holder Funeral Home Owensville, Ind.- --
Fl�neral Director address
SEAL
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(���_� (/�i�% G:;'�j:/ �, �=� c %'i,�i�" . .
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Signed �
Gibson County Health Commi=sioner ,_ ._
Oakland City, Ind. 3/10��7 . �"�
address � date�
Recorded locally in book A'o. x-5� Pnge No.-26 Filed: 3�10�77 '_ .
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