Death Certificate - Pease, Carl W_5/7/1999MAY-O6-1999 THU 09;37 AM CIV[TA�NK FAK N0, �
� ,�' GIBSON COUNTY DEPARTMENT OF HEALTH
800 S. Prince St.
Princeton, Tndiana 47670
, - � 812-385-3831
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: 1 .
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RECORD OF DEATH
P. 03/03
THIS ZS TO CERTIFY�
that according to the records of the Gibeon County Department of Health,
CARL W. PEASE
Died on 10/16/1997 at 6:23PM
Holiday Manor
6th Avenue
Princeton IN
Age at dQath t'J3 Years
Marital Statue: Married
Sex: id
Color; White
Cauae of death: Cardiopulmonary Arreet, Cerebral Rnoxia,
COPD and Respiratory Failure.
Signed by: Lance Payton, M,D.
410 North Main St
Princeton IN
Place of burial Sunset Memorial Park Cemetery
or removal:
Date�of burial:
Puneral hoate :
S E A L
Evansviile ZN 47710
10/i0/1997
Ziemer Funeral Home, Central
626 First Ave.
Evansville IN 4771p
Signed by W . .�ri�� ��
Gibson County Healt ommissioner
Oakland Ci�, Indiana 04/27/99
Address Date
Recorded locally ia Book No. 13 Page No, 49 Filed: 11/OS/1997