Death Certificate - Peyton, Charles N_10/12/1971RECORD OF DEATH • • �
GIBSO\T COUNTY DEPART\IENT OF HE?,LTH
PRI\�CETOx,IFDIa\.4
THIS IS TO CERTIFY, that our records show CHAiiLEB N. PEYTON died
gept. 27 ig?i at-9�15PM—GSh.—C�n._Ho.s�._Pr�nceton. Ind.
month . -day year hour of death . street, hospital, mral
Age at Death 58 ger I�Sale Color �hite MaTTled
years write �chether married or single
Piimary cause of deatli given was VentTiCUlaT flutteT
-Signed by- Bruce Brin�, D.9• Princeton, Ind.
physician or coroner ' � - address '-�-- �— ' . '
Place of burial or removal I+Isple Hill PTinCeton� Ind.
" � name of cereten- � � address �
Date of
SEAL
.� .
,. .
FWneral Director
�fj.K.r��Z �
County Health Commissioner
Princeton� Ind. 10/7/71
address Date
�f
Recor�ed locally in book •No. 8 page I�*o. 38 Filed: 10/%/'jl
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