Death Certificate - Miley, Cletis R_2/16/1984�
R$COBD OF DEATH �
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GIBSON COUNTY DEPARTMENT OF HEALTH
PRINCETON,INDIANA
THIS IS TO CERTIF'Y, that our records show CLETIS R. MILEY died
1/17/84 at 11:45PM Gib. Gen. Hosp. Princeton, Ind.
month day year hour of drath stmet, hospital, rural
71 Male White Married
Age at Death Sex Color Marital Status
years write whether married oz single
Primar,y cause of death given was Dehydration
Terr.minal cancer of luna
Signed by Arun C. Kumar, Mn prin�etn�rn3
physician or coroner . addrnss
Place of burial or removat I.O.O.F. Princeton, Ind.
name of cemeten• address
1/20/84 Colvin Princeton, Ind.
Date of burial -
Fwneral Direc[or addrnss
c: fE fa`t'i:Pe- �C///�'r" %G/'. ���//
SEAL�4 �l,tl� ,'r Signed ��
_ �N � ' ��� �' Gibson County Aealth Commissioner
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� �-;�. �; Oakland City, Ind. 1/30/84
, � < . :c :
6: � .� - address date
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Record'ed�locally in book No. 1� page No. 10 9 ��� : 1/ 2 3/ 8 4