Death Certificate - Martin, Roger John_10/22/2003-:�
GIB�N COUNTY DEPARTMEN�F HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CHRTIPY
that according to the recorda of the Gibsoa Couaty Department of Health,
ROGSR JOHN MARTIN
Died on 09/24/2003 at 12-3:OOPM
xesidence
. R.R.31 Box 49A
Cynthiana IN
Age at death . 57 Years
Marital Status: Married
Sex: M
Color: White
Cause of death:- Arrhythmogenic Cardiomyopathy. Evidenced by: 1.Fibro-
Fatty Infiltration of right and Left ventricles. Resulting in: 1.
Fatal Cardiac Arrhythmia. Associated with: 1. Cardiomegaly.
2. Left and Right Ventricular Hypertrophy.
Manaer of death: Natural
Signed by: Richard D. Hickrod, Coroner of Gib. Co.
425 N. Main St.
Princeton IN 47670
Place of burial Sts. Peter & Paul
or re�oval:
Haubstadt IN 47639
Date of burial: 09/27/2003
Funeral�home: Stodghill Funeral Home, ZNC
304 W. Locust Street
Ft. Branch ZN 47648
Signed by � G' ��4""""'/�' "v
� Gibson County Health Commissioner
S E A L
Recorded locally in Book No. 14
c�����-�v
Princeton, Indiana 10/OS/03
Address Date
Page No. 72 Filed: 10/08/2003
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