Death Certificate - Parke, Elza_4/9/1968° ` - � i
RECORD OF DEATH
GIBSON COUNTY DEPART�IE\TT OF HEALTH
� � � PRI�TCETO\, I\*DI�1?�A
THIS IS TO CERTIFY, that our records
.
� �
eJ- l _-- �� �.
day � year hour of death street, hospital; rural
Age at Death L 3 SeY �-� Color
�� rf'r�.,�.�n.,++i
� years . . . ' . . .�vrite �chether married or single
Primar�� cause of death given wa� ���+� �-����-
Q/t�-r�-v 5�-+-�L.�. l�ev, a...�t+.. �:.._._e...�,
Signed by "-�l_ 1�- �----��1►t fli � � �
, , , ph}�_=ician or coro r , � address � -
. .. .. � � � ~� �
Place of.burial or removal
-name of inetery - ' address
Date of burialS�-�►2- � /N'r►�^�.t^..; `�'i'^�""„' �"`"'� ' �.
-" ' - ' - �neral Director � " . address � � . . .
� �- SEAL �-; , Signed �� J ��4.K� � �
. � � � .� - Gibson County Health Commissioner .
^ - , � �ir,,,..�,lP„� �%—.� -_ 3s�.w �r— G Z
— - . . aaares5 � S _ �_ 6 �. aac� .
Recorded locally: in book No: �"�- SQ page No. � ���