Death Certificate - Schaefer, Martin J_11/29/1984RECORD OF DEATH �
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GIBSO\T COtiNTY DEPARTIIENT OF HEALTH
- PRIVCETOV,IND[aNd
THIS IS�TO CERTIFT, tliat our records sho�e �RTIN JAY. SCHAEFER died
10/26/84 at 8;57PM Gib. Gen. Hosp. Princeton, Ind.
mon[h day pear houz of death street, haspital, mral
Age at Death 51 Sex h?ale Color White�farital Status Married
. years _ a�rite whether married or single
Primary cause of death e ven «�as Renal Failure
��,e�i�,3 ��, Arun C. Rumar, M.D. Princeton, Ind.
physician or coroner address
Place of burial or removal I.O.O.F. Princeton, Ind.
name of cemeterp address
Date of burial 10/29/84 Colvin F. H. Princeton. Ind.
Funeral Director address
SEAL �
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Gibson County Health Commissioner
Oakland City, Ind. 11/7/84
address
?tecordeci ]ocall�� in booi: No. 1� Page I��o. 13 z F�ed : 11 / 7/ 8 4
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