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Death Certificate - Sollman, Edwin C G_1/2/1962' �. _. . - ...�� . _ _ . _ _ - .. " :4-.'_ ..... . . � � :.�.
. .. . . • . +., . .
. LOCAL , - -.: .. � . . � � ' .' .. � � � ' �
. .. .�. .. RECORD,OF DEAFH. ' _ � . . ' ` ' _: �.� _ '.. . _ -' _ .
. -. . .. .-: ..... .- . ... ".' ' ... ' .-::..' - . '..' _ ._ -
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- . , � ��G'IBSON�COUNTY;,DEPi�RTMEVT� OF HEAI,TH . _ -� - � � ' �
-- . � ' ' ' . . '=� ' ' - - 'YRINCETOV. I?IDI�.4\A .. ' _ , - _- ) : . . -. .
;•: THIS IS TO CERTIF'Y that� our records.show.(QL[.u+-�.�:5.!/t�il�r( ..�.� L.wt,rr�-...` Q> ,/, �� ed, .
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_. ����.�/�/ .:. .! (P ..-.��[AF . at S�.'irA h�. r'�..�� .Ol*�l i �� i
, -month _°day � ,year � _ �- �hour of�death eet ��hospit'al�, rural
. �. .- . . . _ - `�.�� . . .. � . .-;
. - � Age at.death`t..`I'.... Sex:.�/I�:....Color...�..: � .�..:.._�. /[.1.� '-...:..... �-�....:.... .. . �.
'-' -- ' -• -�� � .... _ .' `-•a-rite'cchethec.marrted or'single, :' ..
- - . .,. -_ . �'.._. : 'Years':--. ... „ .. ..�.. . :. .: . :
'_.Pt�ary�.cause�of.death:given.was ..�:.!�4�f�f.LG.LY...:...:1..�f.dw(d :....lO���GL.KI��..�1�:�.G(.,.C,: '' '
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, -, . , , � s�cian• or coroner � - y� ��'address:. -; .'- ',� , � � � -
. • �! Place of bur al orrerne�.el � ....,. � � . .... . .. �. . .. nGL��ss,Crt�i.,� GGl �rt��fi. � � �
_ ' ' " ' - n :of cemetery� ' - ; �address••-' • - � - �
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. � Date of buriai�V/./ .j}{.G�. I! l""'r...�!�'�'��. � �.AJ...i.[.�ic.riq • ��-- .
. . � .;, . . / Funeial Director .� - � . address �
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�:.'� C . . '�� ..� � .� . ., _ . '- . ... Siened....,.�.1 . �. ......... ......... . ......... � :�. .� ,-.
-. - -�'(SEAL) � . ' - :- . . . � - . Gibson Cou Health Commisgione� . .
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- Recorded 1cea11Y. ��.�k �o � �_:, Page� No_ f .r.�.... �/ O .>-.�p —� (p / ) � _ .. �.' . . .
' .' _ . -. ., . �.. � -- -. � ... �/'1s;f � / . . . '. �- .
