Death Certificate - Simon, Earl_5/28/1982IZRCOHU OF DEATH
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GIBSON COUNTI' DEPAICTMENT OF HEALTH
� , PRINCEI'ON, INDIANA
TH1S IS TO CERTIFY, that our records show EARI, PE"PE SIMON died
�ti/82 nt 5s15PM Gib. Gen.}iosp. Princeton, Ind.
month dny year . 6wr of death � � atreet, hoepital, rural �. �
Age at Death 5� Sex N� • Color ": Wh• Marital Statua M.
Y�� � wtite whather married or eingle
Primary cause of death given wn�+ Cardiac arrhythmia with myocardial infarEtion �
5��� bY Bruce C. Brink, Jr. , D.0
phymcian or coroner
inceton, Ind.
ea&ess
Place of burial or removnl Holy CT'oss Ft. Brarich�Ind.
name of cemetery address
Date of burial 5/14/82 Stodghill Ft. 'Branch, Ind.
F�neral Direetor addresa
Gc,��;�/��°� .�� I
SEAL Signed
Gibaon Connty Health Commi oner .
Oakland City, Ind. 5/19/82
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1Recorded locally in book No. 10 page No. 6� �led: S/19/82. _ �
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