Death Certificate - Potter, Eugene T_4/14/1978�
RECORD OF DEATH
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- ., _,_. ";' :., , • • � �'� � 'GIBSON COUNTX DEPARTD'iENT OF HEALTH
PHINCETON, INDIANA
THIS IS TO CERTIFY, that our records show EUGENE T.`, POTTER
10�j/77_at ft��opiV1 Gib. Gen. Hosp. Princeton, Ind.
month day year hour of death street, hospital, rural
Ave at Death 56 Sea M' Color wh' 14arital Status _Married
y�rs write wbether married or singte
Primaiy cause of der.th given was Carcinoma lung
Signed
Place of burial or
physician or coroner
a� Maple Hill
name of cemetery
Princeton, Ind.
address
Princeton, Ind.
address
Date of burial i0/10/77 KPndali ���nee�en,�TM�'
Funeral Director address
SEAL
- � L/��s` /�Z � �`�-% < �.0
Signed
Gibson Couuty Health issioner
OaklandCity, Ind. 4/14/78
address date
Recorded locally in book No. 9 Page No. 5� Filed: ' 10�17�77
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