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Death Certificate - Smith, Frederick_7/8/1971�6�€ � s ..w-.. {i ii ;" �i : _ 'T � ..� :�+fi" ; .' � �: e j µ���tr`r�i�� 1 .-. ��4e�� . .• �_I. a 1 . - _ � 4i �� i .t� r��f � sta3 i..'i �.2 4~�ai A.�. �7 �'f ° tf .i:. a .� � M � 1�3 �.� ti"_ ':'�� RECOftD,OF,DEATii. ..� e: • • . 'i , '� F �� ., <z � a �st,� x;_�° t '. ^ ; .. • t , ..� a c � � .�t �3.�,,�� t�f ; ;; S �p '"try-GIBSON:COtiIv^i'Y DEPART\4ENT•OF.HEALTH ir ��,�:.,�R r' � �' �'t , �};� '�� ! -. � � - . . PRINCETON,IA*DIANA� , ' . �� :. � ,� *` � - . S _!F ���'. i �- .�'. '� . j". ' . �• '' "; tl ...t� :s�t . . .-�% �` � y` R t' . . - . `' �� . , '..� ' _ ° _ -.'-, THISsIS TO CERTIF'Y.3that our recoTds show = FEEDLRTCK 4ffiTH + �� .4 �''-'died' . ,< r: r , .. .. - � �; _ �i a. t�Y F �, � : , _ �. t- . . - �- - � ��� Z . .c - . �-� �r ' - � ,..T�tr�td,: �nls� ` ; t5 " � -1971.. at �►e�30AH.Glb._ Gen. Hoap.�-Prinoeton; Ind. i, , >i; � � �� �. j ��».� tIDOnth` �,; „"a,�,� Jday ` � <. � year -. � . � _•: : hour, of, death - . ! - streat -:. hosp�tal, rural ; �:.:= ��: � .:P: 1 r -. . � � � : � �, i , Age at Death 80 i Sen . F[ale V Color : idhlte - �-�" ]�aPrled <� � �.�i. � . �dj }.�% �i . . years� � , ' ' ..> -^ ' . ° : , • write�whether mamed oi•smgle� — �� -� � �� �kF�-e� F.i+..- t ��P�•�:..C1F� ,� .! � �. '-. . .. . ,f., i . °�2j �� .( :�� a,.__ ` . ��o�+�iel .Infarotion � -.;r ., -- .a-.-s '• << <�:- = Pnmary cause of death g�ven.was` - - ' - I `�t �5....,-.1� �r. i _ s , . . , . .. � :! ; eF o#�° �{ ` �,� ~�E. t fl f � �w� �,j , �t•. ,. . . . . }�. � A 3 y� i'r'' i � . �i. ...% �E� •i_`��'S iis i � t �.: ;' .. '..^ r ..,� r"jqyl. . ` ....� �.� $IgII2d. by s R : c � [` a 1 nlr � f'�i _ �''-t..�BTBAC2I-►—IIIfl-: ^ : ` 7 4 . e a � � '. , "� i �,' �S t -r_� . ° physician or comner � ,- � � ., --j - � : . - address - f .��; ' =: ., }�� ' `, t :_: �r'- t.' � -�. � _ . .� . . �.� t. _-iS � � f�- r � " z Place+of bunal or rnmoval ��� Flslnnt Hi�L� :' i� Pt.' Branoh� Ind ':..� '.t r� � . S ���', i ' `. t ; 4: name of cereterY- �_� _� � :4' �. . . .. address�r � s- � � -� = s •�"s:�f� �� �{ ti`'7%7/71 ' � "Iaih.Funeral Home � ' . t:� rarioh 9'. � .o .Date of`buri nd.:. 4 `.-��� "- �. . � � ` -�.� Flineial'Dicector _ . ' ��% a ess t �:. , -•, � 47 ��i �i .. i �. 1i t . �1, ' � . . . �: Y�:. �`.�C � �.�°� �jvr-i � -u d, fi-�SEAL` :� � ` _ ,. ' 5��� • � ` •' -:.��i� !_:. .�.: e - � t. S1% '.e i: . ..F,. - + _ . � , _• . � Gibson County Health Cutnm�svoner %. "�a.�; � a� v .�� ✓ � .� . . .' : �� _ . . . '�..` '� . � '.�' � „ ��` ; � ,��� �, �Prinoeton. Ind. . �':?/8/72' } � r 6' �-� � �E s. �`- � r � r ` �� ' ^. - - ' address� � ... , :(; � .:. ri - Date iF i C t � j'-+, r ' . t ' ' . r F �s : :,, � ij i � r^ �, . • ' 7� �7 ", i� {+ - ` Recor�d locally;in book hro 8� Page TTo� 31 F'ilecl: 8 1. -- .µ _ ,t.,! :g� /f� x. f i . �, � ' � � � , " . t � �' � A' ���. A � i �f '7 j:�. ^�t�t 5 'a '.-i� . . � F . y . . - �� '� °��'a �i ! `: - ' . ,'' r'_ ,1iJ � �. , • C .�a't�y - ` ! .�, . i �, � � � - � '. -^ . ��� ' f .. . . . . d � ) . f '_ �'.� } � � x � ' . � r . ' t : �,. f.`�: n�"� r..�.-= € � � _ - - • � . � ' � P a .. 1� - — ' �-- - � ' � .' � . ' � � • � . - . 's i x♦tY "T��� iS �'r x '- F. ' _...dA...�....._; 5�. _ � : . , .. � .;...� . � .... .r.. �..; . b � ,.',� t ,.- .i �, i