Death Certificate - Mongel, Bertha M_3/15/2002GIBSON�OUNTY DEPARTMENT OF HEALTH
800 S. Prince St
� Princeton, Indiana 4
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
- that according to the records of the Gibson County Department of Health,
BERTHA M. MONG$L
Died on 10/29/2001 at 8:30am
Holiday Manor Nursing Home
305 North 6th Ave
Princeton IN
Age at death .
Marital Status:
Cause of death:
Signed by:
82 Years
Married
Sex: F
Color: White
Pneumonia with Sepsis resulting in Renal Failure with
Electiolyte Imbalance, Stroke Syndrome
A
Paul V. Banning, M.D.
Welborn Clinic
Princeton IN 47670
Place of burial Columbia White Church Cemetery
or removal:
Date of burial:
Funeral home:
S E A L
Princeton IN 47670
10/31/2001
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
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Signed by
Gi son County Hea t Commissioner
Princeton, Indiana 10/31/O1
A ress Date
Recorded locally in Book No. 14 Page No. 23 Filed: 10/31/2001