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Death Certificate - Perry, Jervey L_4/20/1977
ItPCORD OP DE�1TH � � GIP,SO\' COliN'P]� D]'sPAI.T\[G\`P OF III3:ILTFI PRINCETO\, I\DI:\NA ,f{�`I; �; .�'_.. j`;:'".i',T TIIIS IS TO CI:RTII'Y, 'that our recw'ds sho�v '�-' tliea � lOp;:: i�j - �;�e�.::t: s+. i?raticn� Ind. � 6/27/1J7'� �t -, - month da}� }�ear hour of death street, hospital, rural " �.�P I=iarried Age at Death 71 Ses Colm�— \I<irital Siatus }'ears ��Tiie �ehether married or single ; ;VUC3Y'C? 1'u.l 1?"'.'-c:_)'C-G1.^.P. Primary cause of deatli ai�'en «�as�., � .S1eT12Cl �)�" Place of burinl or ! I '.�.: . �LCi'=r .:_� 1-i:. _'r1':lr .� .�ih1. i�hy�i�:::n m' ;.;,ro::c: �- - . a�{.��ess : ':�cl�.lil:'-.. ! i?.11 _ � . L<_'311C:? r 1.:?a . �mo��al name of emneterg . ad<Ires; +_./J����7'�i Lc.l'.) C�L�.TIC'l`1.1 i-iom.� ';,. ;rar?�ii, �.nd. D�te of burinl . F�,,,...�i n��,.�r,,,• address .-. . jJ��j;� �° „ / L'f� ! °�2� �L � /� ( �.0 --- SE:�L �S�ened Gibson Countc Health Comm' oner !i � u�ic"��?__. `?i'::7, nd. -Y/20/%r address date � /, i Recorded localh- in book No. 'T r� Page��1'o. Filed: ���� ` e.•' ' . � ; _ . . .. 1 _ , . _ . . . _ _ , _ ' �