Death Certificate - Montgomery, Ethel_4/28/1986zo
RECOI{ll OF DEATIi � •
GIBSON COUNTY DEPAP.Ti1i�N'P OF HEALTH
PRIhCE'fON, INDiANA
THIS IS TO CERTIFY, thaC our records show_ H`�'HF.T, MONTf.nMFRY _ died
10 22 81 .� " :
._ 1 1_____�t___-5AM Owensville Convalescent Center
month day yexr hour oC death - street, hospital, niral
Age at Death 10� _Sex_.— Fe• _Color Wh�Marital Statuz W.
peais �vrite a•hether mm•ried or single
Primary cause of death given wus__ Cardiac arrest __
Sie�ned by__ Terry South, I�.D. _ Pos�.+ille, Znd, - __
physician or coroner addre;s
Place of bm�ial oi• �•emoval_ Antioch _____ ___ Owensville, Ind. __ __ __
- name oF cemetery nddress
Dafc of buriaL 10�23�81 Holder's Owensville, Ind.
Funeral Director address . , �:,;
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SEAL Signed -� ,'" r��
. Gibson County Healfh.Gommi oner -?c�
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Oakland CitY. Ind._. ' "�/2�:8?
address � date
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Recorded locxlly in boolc No.--- 1�--Puge No._ 5� Filed: _ 10�28�81— ---