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Death Certificate - Smith, Ollie_3/15/1977_e , �c .4',_._ ' . . �� - "' "' _' _. ' '��_. ' � . ' ,� . .� � V , RRCORD OF DR:1TH , ' :-, . , . .. . . r' . . . . . � GIBSO\ COtiA�TY DPPAP,TIt];NT Or IIPAI,TII ;; �.+; . . . • .r � �, PRWCGTO\; I\DI:\N:1 . � -' .'-� . .. . : . � . � � . - ' THIS IS TO CERTIR],that our�recoi•ds sl�o�s OLI,IE Sb4ITH � �1e� ; �.2�22/1977 �t 9t4,oPbt? Gib. G�ri._Hosp_._Pxincetsn,�n�. '�-"� . month � da}- pcar � lio�r of dealh � street, liospitel, rural . . .. � • Age at Deatl, 66 Sex_—Ti�ale _Color Ne�ro�taritial Si.ntus �IaZ'T'ied � . pcars �crite whether married or single • Primary cause of.dcutli given ai�ns—Pulmonar_�embolus ` '- Signed U}•' '•Vm. R. ia'ells',• 6i.D. Princeton,. Ind. • . phpsician m�coroncr addr�ss . . Place� of burial or remo�:il � sand Hili Princeton, Ind. '�..� . '. n:ime of cemeicr�- , address -= Date of buria]?�127 ' Ker�dall_r^uneral_Home Princeton, Ind. � � . � I�uneral llimctor � �ddress _ , :r , _ . . 1 � .� � � . . - � � . � � . . � . � . �iii L , . . , :,'., v . �_�.. ; :,, ii . SE:1L ai�ned. �J � - � . . � Gibson Co�mtq }Icalth Com ssioner _ , `' _ Oakland City, Ind. 2�28/�7 , . . ' . address date `. � Recorded locallp in Uook A'o. 9 r:�se ;�*o.— 37 r;��: . 2/28/�7 �: - e