Death Certificate - Martin, Roger John_6/18/2004�
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GIB� COUNTY DEPARTMENT� HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CHRTIPY
that according to the records of the Gibeon County Department of Health,
ROGBR JOHN MARTIN
Died on 09/24/2003 at 12-3:OOPM
Residence
R.R.31 Box 49A
C�mthiana IN
Age at death . 57 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Arrhythmogenic Cardiomyopathy. E1�idenced by: 1.Fibro-
Fatty Infiltration of right and Left ventricles. Resulting in: 1.
Fatal Cardiac 7arrhythmia. Associated with: 1. Cardiomegaly.
2. Left and Right Ventricular Hypertrophy.
Manner of death: Natural
Sigaed by: Richard D. Hickrod
425 N. Main St.
Princeton IN 47670
Place of burial Sts. Peter � Paul
or removal:
nate of burial:
Funeral�home:
0
S E A L
Haubstadt ZN 47639
09/27/2003
Coroner of Gib. Co.
Stodghill F�neral Home, INC
�304 W. Locust Street
Ft. Branch IN 47646
Signed by � G� i�l.ctcll/( hfV/
� Gibson County Health Co issioner
Princeton, Indiana SO/09/03
Address Date
Recorded locally in Book No. 14 Page No. 72 Filed: 10/08/2003
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JUN 18 2004 Q O�, p�o/ � 3.�
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