Death Certificate - Smithhart, Leroy_4/2/1975• • , RECORD OF DE:�TH •
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GIBSON COUVTY DEP?.ET\IENT OF IIEALTH
PRINCETOV, INDIANA
THIS IS TO CERTIF], Chat our records sho�v i;�sROY i.S1P:RLY SI��iITfiAhT died
\`4� ��� R ;i1 Owensville, Ind.
''``� Mar. 27. 1977 at 2e1b! ? '`
�';',;;;.e�;}��\�' • month � day year hour of death street, hospital, rural
'.;�r,'- ��. - 57 i��Iale, , ,�,` , �'
Age at Death Sec Color `��`h •_lfarital Status P?arried
�'' . }'ears _ wzite whether married or single
." Primary cause of death given was I�yocardial infarction
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Si ed b- �+larshall i:9iller, I•1t.D. Cherry"St. r.vansville, Ind.
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... phcsician or cororier�•' � address _
`�` ' � i�Iaum�e Owensvilie, Ind.
,...• , Place of burial or removal
� ' name of cemeler}� address
``�,,<;,, Date of buriat 3�3��77 "�=�folder Funeral iIome Orrensville,Ind.
, _, � -� � � �neral-Director address
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,.f � SEAL
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Signe �
Gibson County Health Com sioner
OaklandCity, Ind. 1H/19/%i
address . date
Recorded loca115• in book No. n-52 P�ge No.�7 Filed: �%/19/77 -
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