Death Certificate - Powell, Ruth A_3/20/1975�
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RECORD OF DEATH � �
GIBSOI�T COUNTY DEPART�4�\TT OF HL�LTH
PRIVCETO\*, INDIA\A '
THIS IS TO CERTIFY", tltat oar records sho�v GEORGE $. POWELL
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Dec. 12, 19�4 .a�)_�40AM Gib. Gen. Hosp. Princeton Ind.
_..month day yeaz . ' hour of death.� . �_ street, hospital, rurdl-�. -�
Age at Death 9� Se� Male � Color j�hlte _lIariial Status 19aTTled
years write. �vhether married or singl:•
Primary cause of death gi��en was Acute conRestive heart failure
Signed by R.- S. Mm�lrny� M Tl p,.�nnot������
� phgsician or coroner address
Place of burial or removaL T.O,O•F,__ Print.�t9n, Ind.
name of cemetery address
Date of buriai—.�_2/__14/7b Colvin 3c Son Prince�ton, Ind.
f'uneral Director address
SEAL
J�r�ff� � �
Gibson County Health Commis;ioner
Princeton, Ind. 9/17/�5
address ��
Recorded locally. in book ATo._� Page No. 108 Filed: 12�17/7�+
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