Death Certificate - Passwater, Rex L_4/8/1986RECORD OP DEATH
�
( ��
GIBSON COUI�TTY DLPARTAiENT OF H�ALTH
PRINCETON,INDIANA
THIS IS TO CERTIFl, tl�at our records
REX L. PASSWATER
March 25, 1986 at 10:33 P.M. Gibson General Hosoital Princeton In
month day year hour of death street, hospital, rural
tlge at Death 81 Sex riale T+lhite �didowed
Color llarital Status
sears write whether married or aingle
Frimary cause of deain given �cas �cute hlyocardial Znfarction, Cardiomyopathy,
Cardiac Ishemia, Congestive Heart Failure with Edema
Signed by- Bruce C. Brink Sr. D.O. Princeton, In.
physician or coroner address -
Place of burill or removal Columbia Church Princeton, In.
name of cemetery• address
Date of burial March 29 1986 Kendall Princeton In
Fhneral Director address
SEAL
signea "� `i!"/ yr"yy�°�fly,�•/y,?j
Gibson County Health C mSssioner
O land Cit In. 4 7 86
address ��
P.ecorded )ocally in book No. 11 Page No. 8 F�ed; April 7, 1986