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Death Certificate - Ross, Harlan_3/11/1974% . . �
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.' , CITY PEPART3IENT OF. HEALTH - -
. � . . - PRINCETON, I\�DIANA . �
THIS IS TO CERTIFY, that our record5 sho�•_-iC:-rR.t,C_o=,-z/ �. �Ce-��/_ died .-
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(/ monlh � aaY yenr . .. hour ot dcach ----- . street, hospital, rurat
Age at Death��_Se�� ---Color �-�-�/�
-- yeais % - e -- - ' --' - -- -. u�rite w_hether merried or single _ ----._- _ T
, Prirtiary cause of: deat�� gieen was_ �-!-`�-� ��c�U �._,_;t,�/ ' �
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Signed 6y-_�^-� /�'a_+C.c/ --_.�tr-�,�%�� --- ----
. . . P� or coroner_--_— eddre�s-.�_— -- �
Pl'ace of trurixl or removal _}���° � �,��``-�/-���m..�.ca .
' //� n-e(ne o( crmeten•---- ----�---- � idre�� -.✓— .
G�I ' _ 'iti-vn.�-vr�/ s.�j .
ISate of burial �-� <� - � �''_ _��� �L!��/ ,
. _ _ � _ Funeral lilrertor - - yddress - . � .
',, .SE:AI. Signed .J`r,(�C-G�-!-'?-�� � .f�.a-?��al
r -----Secv.
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' � _ ' • . _ . ' �: address � . " ..--____ . �—
� r. . �� � ' - � date
Recrordeci la`ally'in�!Iwok No.--%-----.--Page ?�To. � � --- . - -- • _ '
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