HomeMy WebLinkAboutAff - Reinhart, Richard_8/18/1972y'._ . � -
RECORD OF DE:1TH • � •
GIBSON COUNTl DEP�IRT�IE\T OF HE�LTH
- PRI\CETO\, I\DIA\:1
THIS IS TO CERTIFY, that our records sho«� K.4��Ii��TF 8 R��P]FI14�f�t� ��
_D�Cem�T 4 1970 at�s�,SAM Forest Del Nrsg. ftome
month , da}- year . hour of deathpTlIICetOri� ��4E�,.hospital, ruial
�1ge at Death 82 Sex Female
years -
Whlte Widowed
�crite a-hether married or single
Primar�� cause of death gicen was �YOC&Tdial IYlfaTCtiori
- g;g,;�.U�. William A. Wells. M.D. Princeton, Ind.
�' � phcsician or coroner � " - � - — -� - �' address " ` � �
Pl'ace of burial or removal � S't.- Joseph 'Cemetery– –"---°'--�Princeton,— Znd. =?:----��
name of cemetery address -
Date of
FLneral Director
SEAL '•- „
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Gibson County Health Commissioner
.�� % 5 " Princeton, Ind. 12/SO/�0
" � ' address Date
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Recorci'e_d lceally in book \To. 8 page No. 1Q Ftiled: 1��Q/7�
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AFFIDA\%IT OF llEA"i'H & HEI�SHIP
(OF Katherine O. Reinhart DECEASED)
STATE OF INDIt1ATA )
) SS:
GIBSO\T COUNTY )
S_-.i:=.H C.1-Z,LEIQ , being first duly sworn on oath states:
That she was well acquainted with the above - -"
, i
named deceased and her family. .
That said Iiatherine O. Reinhart died intestate on or about the
4th day of December, 1970.
That the estate of the deceased has not been administered.
That said Katherine O. ReinharL was married but once and then
to Dan P. Reinhart who died prior to ihe death of Katherine O. Reinnart.
� That the following named were the only childx•en born to said
_. Katherine O. Reinhart:
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.: :
1 DATE OF D9TE OI'
-- ------ -I�TA7�21��— - - � ---- - --- - BIRTH - -� - - - - DEAT,II-
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Richard D. Reinhart llecember 3, 1917 Still Living
Paul E. Reinhart December 21, 1920 Sti11 Living
Lawrence E. Reinhart January 6: 1914 Still Living
Roiamilda Zimmelrman August 16, 1912 Still Living
Katl�erine O. Heinliart left surviving her the following named
persons �s her sole and only heirs at la�v, to wit;
Richard D. Rei�il�ari La�arence E. Reinhart
Paul E. Reinhart
- Affiant�furtlier sai':h not.
Roumilda Zimmerman
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\��.i�f�' l'!.. C�-4�(.l�"�
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f'�' __ Subscribed and sworn to before me ihis 18th day of :�c]ust
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'f_ . _ 197 2� �) �iC.(-ll"`-�- ��
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- . Notary Public •
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' My Commission Expires:
�� . Nov.2,1972
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