Death Certificate - Mounts, Vesper O_10/11/1978�
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RECORD OF DEATH
GIBSON COUNTY DEPARTBIENT OF HEALTH
� PRINCETON, INDIANA
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TffiS IS TO CERTIFY, that our records show VESPER 0. MOUNTS died
lljil/77 a} 3=30AN Gib. GeneHosp. Princeton, Ind.
month day 1'ear hour of death _ street, hospital, rural •
Age at Death 6� Sex M' Color �' 1�4arital Status ��
years � write �vhether martied or single
Acute gastric hemorrhage
Primaiy cause of death given was
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Signed by R. E. Weitzel, MD Princeton, Ind.
physician or coroner address
Place of burial or removal Patoka, Ind. __
name of cemetery address
Date of burial 11�14�77 Colvin & Son Princeton, In�.
F�neral Director address
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SEAL
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Signed '
Gibson County Hezlth Commissioner
QaklandCity, Irri. 14/10/7$
address da[e
Recoided �l'ocally in book \To. 9 Page Iv'o. 52 Filed
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15/77
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