Death Certificate - Pruitt, Jack Tom_9/19/2001GIBSON �UNTY DEPARTMEN�OF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
JACR TOM PRUITT
Died on 09/23/1998 at 1:56am
Owensville Convalescent Center
Hwy 165
Owensville IN 47665
Age at death . 73 Years Sex: M
Marital Status: Married Color: White
Cause of death: Squamous Cell Lung Cancer
Signed by: Chester Burkett, M.D.
P.O. Box 550
Poseyville IN 47633
Place of burial Liberty Cemetery
or removal:
Date of burial:
Funeral home:
S E A L
Cjmthiana IN
09/25/1998
Werry Funeral Homes, Inc.
16 E. Fletchall Ave.
Poseyville IN 47633
Signed by � G �j`����- " `�
Gibson County Hea t Commissioner
Princeton, Indiana 09/19/Ol
Ad ress Date
Recorded locally in Book No. 13 Page No. 72 Filed: 09/25/1998