Death Certificate - Stout, Glen_1/28/1994c� � u s c� rv c c� � r tir r� � r� zk k�r r� �. r� �a �=
300 S. Prince Si. �
Princeton, Indiana 47670
812-385-3831
RECORU C�F DEA`Ct-1
i-i L: � L, T H
p�q-�lo��
THIS IS 1'0 CERTIFY
that according to the records of the Gibson County Department of Health,
6LEN STOUT
Died on 09/30/1993 at 2:OG AM
Gibson General Hospi'tal
1808 Sherman Drive
Frinczcon IN 47S?C
Age at death . 56 Years
Marital Status_ Married
Sex: M
Color: Whi'ce
Cause of death: Cardiac Arresi. Minutes_ Peri carditis, Monihs.
Coronary Artery Disease. Years.
Diabeies Mellitus, severe Peripheral Vascular Disease
Chronic Obstructive PUL Disease.
Siqned by: Rameshbhai P. Patel, MD
105 N. 2nd Ave.
Princeton IPl 47670
Place of burial Sunset Lawn Cemetery
or removal:
Harrisbur9 IL
Date of burial
Fvneral home
S c A L
10/03/1993
Gaskins Funeral Home P.C.
109 W. Poolar
Harrisburg IL
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(�AN 2 81994
�. ,d' . J` s
AUDITOR�
S i gned by -- —"X-�`F-�-�L�_`---- �h�----
Gibson County Health�mmissioner
Oakland Ci'ty,_Indiana _ 10/08/93
Address Date
Recorded Iocally in Book No. 12 Paqe No. 75 Filed: 10/Ot3/19°3