Death Certificate - Racine, Maxwell J_10/25/1983RECORD OF DEATH � �-
GIBSON COUNTY DEPARTn3EATT OF HEALTH
PRI\*CETON, INDIANA
THIS IS TO CERTIFY, that our records show MA�I^1ELL J. RACIPIE died
1�4�82 at 12°35PM Gib. Gen.Hosp. Princeton, Ind.
� moath day yeaz hour of desth street, hospital, rural
Age at Death 49 Sex M• Color wh' n4aiital Status N'
yeara write �vhether married or single
Primary cause of death given �vas Myocardi al i nfarction
Signed by Richard Gries, M.D.
physician or coroner
Place of burial or removal Walnut Hill
name of cemetery•
Date of burial 1�7�82 Stodghill
F`uneral Director
Haubstadt, Ind.
address
Ft. Branch, Ind.
address
_ Ft. Branch, Znd.
aadress
W���° ,��
Signed
Gibson Countp Health Commissioner
Oakland City, Ind. 1/7/82
address date
No. 56 Filed: 1�7�82