Death Certificate - Ross, Harlan_3/11/1974% . . � LJ� �. . .- - _ _ . - . .. . �. . aF nE �� � t� .' , CITY PEPART3IENT OF. HEALTH - - . � . . - PRINCETON, I\�DIANA . � THIS IS TO CERTIFY, that our record5 sho�•_-iC:-rR.t,C_o=,-z/ �. �Ce-��/_ died .- �� cJ-a..K..-..n.�..�--/ '7--- -� �.l-(��.— --1t�1�_'_^Z.� I ' �?,-,':_� �6a,,��"':�J�fv ,�j . (/ 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,�/ ' � -� � ' --- - - ��� , _; ��,��,...�, � c _ . . Cc,r�:�.�`,,,.� , . 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. � � � ��j �f�C ,r..�.�.r....� � -� � --6 ' � _ ' • . _ . ' �: address � . " ..--____ . �— � r. . �� � ' - � date Recrordeci la`ally'in�!Iwok No.--%-----.--Page ?�To. � � --- . - -- • _ ' ' � . ,,�.�:G��, , � j q /o �f . ' . _ ' � . ' �. . , •' a': . � ` • . . " • � y . �2 . �. � " . • . . :. _ . i N