Death Certificate - Swain, Essie_2/23/1977� RECORD OF DEATH --
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�GIBSON COUNTY DEPART'�iENT OF HEALTH
PRINCETON,INDIANA
TFIIS IS TO CERTIF'Y, that our records show FSSTF T1A N
' died
Se te�ber Oaklard Cit�, Indiana
P 30 196E at 2Y''; Cakl&nd City nest ?3cme
� manth day year
hour of death street, hospital, xvral
Age at Death_ R1 Sex FPma� P_Cq�or "•;;,5 �o
"'inalg
� Y� - � n'r�te whether marr�ed or single_ �
Primary cause of death given was—_ IIypostatiC nneunoria
, Signedby riov,ard _�. Ropp, D,p, Oa'r,land CitS, Ind.
, � ph}-sician or coroner �
_. ' address �
Place of burial or removai I• �• 0. r. Cemeterv r„� .,., T_a
� name of cemetery address � -
Date of �buria 10/2/6� Colair. & Son ?rinceton, Ind. -- ' -
, . _ . .. , ` . .. , F�ner31 Director ... ^a ss � _ - . . .
. SEAL:. ,:...,, , � j � ' _ -
- y<. I C . Signed ' w i�0__=,� ���
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� . _. _ � � ` . _ �bs i Gounty ealth C7fmmissioner •
- -•.� . - � Princeton, Ind. 10/28/68 '
' - c � address -
. _. . � _ . . . � Date
Reco*ded locallp in book ro. �-K;1 nage I�To.__il`%i__F��ed: � n/�/�R
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Page `o. -% ; Prepared by BENTON TITLE CORPORdTION Princeton, Indiana
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