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Death Certificate - Smith, Ora Edwin_7/29/1965J
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RECORD OF DEATH
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GIBSON COUIQTY DEPART�IEATT OF HEALTH
. � � � � � , � PRINCETON, I\DIANA � . � .
THIS IS TO CERTIFY, that our records show �/�� ��' died
�� .�' G ( 95�3 _ at � 3 o C!- 7h . !J".��.°'�,-c.t,f'�
�month , � da}• � �year . � hour of death � � �street, hospital, rural
Age at Death 6� Sex /� Color �'�`�-�- ��`^"-"-� �
� _ years � � � . � . � � � �crite �chether married or single -
Primary cause of death gi��en
Signed by 4�
Place of burial or
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7'al .8''
physician o- -. ��n
�_�__ ,
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._. " .. __.-r� . ".'
� name of cemetery � - � ' � address � �
Date'of:buiial�-a:�- `�.fi..' ��c2`Lu/./�r..c.;,..�^-.�VJ�V-o-�n1J - V'`'`'`"`°'"`,LC`' �+-�.d : -� ...
�`r` . . "' . Funeial Director . � ' � � addmss �
' �., i
_ -�� � � �i �o��
SEAL• � '; - Signe ,cZCL„�"".,�
� ` � � • ✓ � Gibson County Health Commissioner
�-;�;�-d . _9�-i-s� . . {�-,�..L'�,�?„.,� �_a�-�s-.
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- �;• ,�•�' " ' � � ' address —T � - date
. , ��^•^ . - .
Recorded locally in book \o.-� `'% z—Paae No. /O � •
