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Death Certificate - Rostron, Caroline_4/2/19731' `2� ia :. . .r . " _ ' ' ..'. . . .�v . � .. .� ' . ) r : ". . � •.� : . . . � .. , ..' . . . ' � � " RECORD"OF DE:1TH . ' ' . . , i, " ` . . .' �, . .', ...:� . _ _ � GIRSOV COli\TS"'DEP�P,T�IE\T OF IIE:4LTIi_' -- - - � � � , .,. rrz��cFTO�. r�n�:��a : _ , . :r _ .- . - _ -. . . , . . - t ,' . °; :�•_� :.: ' '' " . CAROLINF' ROSTRON ., . . �- � � �� '. TfiIS"IS TO CERTIFl, tliat oui• records sho�e ' _ _ _�9�� i` ,,.; i� ;, . --- . . , - . .. .. ' _ . � . . - . : � - . ' � �rict: - - • . 8 � � ' ' 1_921 = at 6AM__30ZMsin �Street ,Haubstadt,;>Ind. ,�: �. - +'� .month"+� :';,,i�„day� ° � . }�ear ' . hour of death • �� street, hospital„rural �• � •. . � �. > .' ��;,,...,� . _ - . . ' . .� . . .._9ge at l5eath`=�g •' Se�em�31e . Color Ldhlte MarTled • - - } r' ' ". -i , "',- . ' pears . , - �criie �cheiher married or singte ". ' ' � - � , i '� � `.�.;. .'.'..' ".'.. 'ti�. .. ". .. _ ' _ y .. ji• ---Primaty cause�of.death.giSen,wac ' 'Pu1moT18Ty CaiD�sem9 - •'�•� _ r..,; . ., - - , : , ,- - - � � ,. t . .• - �. . . .. .. . ` -. — i c;e P,� t,v=! Harold G.:_Petit�ean, ,MD :. '' Haubstadt, Ind. • ':. ' � -` �phi'sician-or corbner:' :i?-. l;r:. � l �t',^'^ address�': , " "e '- �. - � . ..+ - .�.; � _: . . . ^ : , . . ., , . . �. �.. ` Place'of burial or i•emoval ; 3aTnett_Chspel �_E1heTf_�ld_�_Ind. ' � � name of�cemeter}� �� address '- � :(-` .. . . . -^ , ' . , � - :i � Date of burial r 14/�0/?1 r" _Vob�cmari_Eunersl_Home-_ __Elb r.feld,'�nd. ._ - � � . . t �'< < _ . k'aneral D�rrctor . add � , ., ` �. r f =' ss � . " - . � � � - . . � s, t:�. .S�Ali � � � �>_,_ . Signed__ ', = � � �" �r.s° p;,,'. ' ? ,. - - - , � � � � Gibson Counic Healih Commissianer�- � - � - a� � _ ,, � : � . . ,•� Princeton, Ind . 4/2/73 .. � — _ - ,� t' . . . . - . . address . . �_ . _ Dare � ' �.,.!:-.. d __.`"' .' '. -.. . . . � - � .-, „ ` .. � ii=. . . . _ �. P.ecof�ded.locall� �n.Uook \o.-H-51 Page \*o: • -Lq' ` Filed:-1Q/8f21 ��. .,:: ,s - � ... - .s !.- - - . - � _ :: ,' . ..-�- -, ; • {y .5. � � �. "- l. .. � • . ! �1 ♦ � 4.. t J F. � . . . . . � _ . . e 1 1 � . ^tr �rr� <' l.. � �. + - . i . • � � . . . . . . �. . . i.•- • . t. . • . _ . . _ . _ _ . . . �� 1. .�. :• t . ' , • . ' . _ ... ' ..: i1 � � i '� - �. _ _ _ s . ,. : i=_ . � . _ � . — .—' ' � ' . . . . . . . ' . , ' . __ _ __ __" --. — . . . ''- . rr .- . �.'.. ' . . � . . -. . �. , . . . '- . .. � . . .-�' . .. � . ._. . - .. . . ..