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Death Certificate - Schaefer, Marcellus_11/3/1971� _ ,. . . - . . . - _ Si t 4 n • � � � �` �`- ` ' � � � R a- - - --.�`..-� _-`< _ ` _ _ _ �s - _ .i ' l - - . . . _ ^ . � , i=_"_ 31 `��� 3 , T .. t ��.�7tc t. .s ..�sT.� . . s <. i9i. P� . ' � I F ii f- e ;..< ri z . t t Yc a� � s: � �F -�. � . 7 i-��i'f e � c- � ��. a ' 1 � E: �a. 9 , , . : � - r .f .Y 4 5_ �t •�� •�i r i�:-� C 'RECORD �OF=DEATH}- ' � � i { " t � .x" . ' , . ' = Y' t � . ` : ;: ` V - �3..�.�: . ' . ��..f-,- , , ! - �_.� �:�i .5_.�-1 i + .� G t � i � e. 'GIBSOV COU`TI.'DEPART�4F\T OF:HE9LTH - � :�� � PRI.\CETO\, I\DI4\ 4 - +-` r..,.: � _ .�a j ' ..- . . . .. ' y ... . S .„ i _ _ . �� ' '~ ,� ' '.( .:: - � ". ; . ; . ...: t ... . ! ' .-_. :: � � �- . �r. , � THIS�IS TO CERTIFl that our records sho« MAiiCELLUS'JOSEPH•SCHAEFEA '� �� 4 . .. �. . . �.�Q�• � _ ♦ l . • _ . .>. . ' ' � `�.. c . �.. ~I •.i.. 2$ .1,971 at . ' 5AM -. ' gaubstadt �-.Ind. , _:�:?;�,� � . 'h - inonih. � , �day.: �ear . , -:hour of death. -a�,�; �; ,- s[reeY,-hospital,.rural ��� � . Age at Death 4� �- Sex � " t3�1s Color.�-- .. , TiThi.te ' -' _ - " - ' - � �ears �rr��e� — I �- ', _ ` ...: - � . . . ..-', , . - ;� � .��.:.`- ... - «nte.�vhether married or smgle - . . . a ' . . � +_.� — {-. _Piiman .ra,ise nf_death oi�en v:a� _C^ CLa���.�'v_�b9s�s� . — �` :- � — �'+ � - ;� �i. � � - ; � . `. . � . � . . � _ : . ' !_. . _ i,l - Signed b�- '' ' '=Aarold G. Petlt�eari; r�n �Haiibst�dt_�Ind.� - � :� ';/ - � _ ' :: ',.,.. � physician or coroner . :, "" . � .. `• - . ". . . � address- .: ;. •_ _ . . Place of bui•ial or removal • • Sts. PeteT & Paul � $aubstadt, Ind. ""`�` , ' . "- . name of cereter�� : - - _ . address ._�. - . . . � Date of bu�•ial ' 10/28/�1 �_` - Wade Funeral Home •" aubatadt._Ind. � =' j - � ^ F4meral Director , . - : � �f a mss � - � -" -- SE9L .. ._ � . . - _� Signecl � u/ �%(`p � - < - _ v � � �', _._ , . Gi6son Countp Health Comm�ssioner x t� '" — ' _ � I , . � T� � ¢ ; ' .''- _ . ; �Princeton. ° �nd: '� " �10, 2 /Z.:�. i - ' �.�� _ � . i �� , address Datei: '� ... .. � p� ' �a � ' ! �ii . -*` ; Reco'rded locally m lwok�No.' ��'•` R -$1•'`.Page \TO � f� �' ?0 --Filed : •t-1•0/28/71� _ {,f..: . _. _. ;t- -•,� ,_ - - Y _ � , ,� , � � ��'s , �. ' � . _— ". ��4' . t ; . ._�. F S � � , . � , �- • . � - � • ,, : y. , _ ' _'� ` - ' � � , -t' .. . . . . . -�;- . � •' ^� � .. r 1 .E ;E. . .a - . - . , _ . ._, . . . , ....._. _ . . :3 - . "' i t t •z ' ... .__ . ... .. _. ' — � �