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Death Certificate - Peyton, Virginia R_11/28/2001
' 11/27/2001 14:05 219-�451 RON SHARONF� PAGc 04 ' � I �� ; ' . � " �: ;. ; ;-1; . , ,::.:.; '''.'GZB'8`OiV � CO:rtJi�i'TY I?.�PAR�i1-EN,T OF' H�AL'FFi . 800 3. PTi' ce:;9�• . . � ' Priticeton,' Ind�ciia.s47670 ,r:. :, BY2-385-383'1 ? � . REC.OF2ID. OF _i :I3:�ATii E: ' . - . � . � � i � . . . � . . . . . E ,�s. �s �a ;�� . ; � tbat nec"oi�rig. to ;the sacords of the Gibs� a Coimty'DeP��ent of Health, `VIRGFNTA R.= YTDN: - ... . �: � :..•;:;;;:; :..:,:;,:. : . .. . .... ,-. . � � Cie; :;°.'�;s�,":`<_'.:-::;:;}.: . .. I. '. . . •' `. .... , . .. �'ed-o'n`"'06/30/1992 at 2:A0'P:M. ;.. � EoeQSt...Dal_.Sonvale�csdt.:Aen�er;. __._.._--..--. - ---° — ' '---> � _ _ _. . _.—.�..._ . .... . , ..� __._: ,.:.. ...:. f020 Vine Street I` Pririceton IN 4Z670 i � ` ,� _ 's Age at deatL '•_ b4,Years , 9ez:.F � : ;f. -- .. . � '.. . ' � . . . i.�; . . . . - :Meiital Status: Married. CoYor:`.�ite:: :`, ' . " , Catiae of death: Cerebrovascular.Accident;°sndGen Diebetes mellitis Type �I : _ ;�: PreVtous:(strcke). i, : recent FracEnred Hip � ? } � ".Signed.by: YLil:liam:;R..: kells� PID ! , 510 N:?[8fa:'St.' i .; • Princetoxi.IN .47670 t i :. : Placa of burisY White.ChurCh CeMAfCx'y i'. or.renoval: . , .:. ,. �i i: , � • Princeton IN 47670 � � . � . =:.�,: ,: .._.__. -. .. _ :.�..�-.:Y�.•�:::_.... . . . "' _ .. ., .�...� .__.� . . � _ . . ..:�.�a' ' :_:_.�....._..._._'. .-._ ._.._..... ._.. �. - . ,. .. . _ ._ _ IInte of burfia�y-' �Fk3J;1.9.42 ; ' . �..II'�n...�'I"�. ' � ,� pa�@i�al hoe�e: Kendall F�neral Aome ' � ; � ;:: . ': �.- . , _ i i - 520 S. Hdin St. I Princeion_IN 47670 . i.: �_ � _ . : � •i, i � . . � . 3igned by, . f � .• +q'►2 �' � _ Gfbson; Count}? Health wissioner � . ` - ; I' ; - S:E-A.L ::�. , - On�lcnd��Cttv ' Indianu 07106/92:: - � 'pddresa. Date _ �: . � , - ' �. " � I r�i� � . ' �' �. :� . . � `!, `3tecarded..loca'iFy::in Book No, 12 ,Pnge No.:Al Filed� 07j06/i99.2 l�r� r�e�-for� • I ; � . . •.. . ° -iq G�3�i��0 . , .. _ . � ;. ,... .... 0 _ .: >. n ia- o� i53-�