Death Certificate - Stott, Melba E_12/28/1992RECOHD OF DEATH : � • � e
GIBSON COUNTY DEPARTbIENT OF HEALTH
YRINCETON,INDL�NA
THIS IS TO CERTIFY, that our records show MELBA E. STOTT � died
9/6/79 at 6PM RR#2 Princeton,Ind.
,month " dny yenr hour of death street, hospital, rural
Age at Death 57 �ex Fe' Color Wh' Marital Status Married
yeare �vrite u�hether married or single
Acute myocardial infarction
Primary cause of death given w1s _
Signed by Bruce Brink, DO Princeton,Ind.
physician or coroner address
Place of burial or remocal Archer _ Princeton, Ind.
name of cemetery address
Dateof burial 9/9/79 Colvin Princeton,Ind.
Flmeral Director address
� �i'�!// `�i%'ZC � ""/-' ' C �.[/
SEAL Signed
/ (�
Gibson County Health Commissioner
_ Oakland City, Ind. 9/17/79
� address date
Rewrded locally in book No. H-5� page No. 57 Fiied: 9/14/79
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