Death Certificate - Smith, James Shirley_4/9/2012� IS?ISIANIOFF,ICIALICOP,YIOFiRECOHDiOFIDEATH�ORIGINAL�COP.Y(ONIFIL'EIATIINDIANA!STATEIDEFARTMENTIOF�HEALTH■
GIBSON COUNTY DEPARTMENT OF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CSRTIFY
that accordiag to the records of the Gibson County Department of Health,
JAM$S SHIRLSY SMITH
Died oa 11/29/2000 dt 7:30 PM
Good Samaritan Nursing Home
210 Gibson
Oakland City IN 47660
Age at death . 82 Years Sex: M
635193
Marital 3tatus: Married Color: White
Cause of death: Acute Coronary Arrest, Dementia, Post Traumatic Stress,
a Depression, Tobacco Abuse.
a
a
Signed by: Terry Gehlhausen, DO
Hwy 64 WeSt
Oakland City IN 47660
Place of burial I.O.O.F. Cemetery
or removal: 1015 N. Hart St.
Princeton IN 47670
Date of burial: 12/02/2000
Funeral home: Colvin Funeral Home, Eac.
S E A L
425 N. Main St.
Princeton�IN 47670
Signed by f"""""C�,,u�.1�rAQ
Gibson County Health Commissioner
Princeton, Indiana 04/09/12
Address Date
Recorded locally in Book No. 13 Page No. 132 Filed: 12/06/2000
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