Death Certificate - Shipman, Amos_5/19/1987�
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' RECORD OI� DEATFI I
; I GIliSON COUN'PY LI�E'A1tTil1I�NT OI' llls'ALTIi
i PItINC1:TON, INDIANA ,
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TI-Il5 iS TO CI'sRl'll�l, that our i•ecords show_ 11MOS SEITPh1nN ,��«�
January 8,_].987 ,it 4:22 P.M. Gibson General. Iiosnital Pr.ince_ton, In_
motiLh day ycar hour of dculh sG•cet, 6ospiL:�l rural
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Age,at lleath �� Ses r�ale �����. l4hi.te��;11•ital Status_._�`1ar.r.i.ed _
1 ycars write «•hether n��rried or single
Primary cause of dcatl� given �vas Carcinoma ( squamous cel.l. )
Left upper lobe ( 5-Months ).
Signed by William R. Well.s, M.D. _ PrinceL-an, In.
physician or coroner nJdress
Place of bw•ial or removal
Maple Hill Pri�lceL-ori, In.
narne of cemclery address
Dateofburia! Januar�� 10� 19II7 Colvin Funeral llvmc Fr.inceL-on, In.
, ' � I�ncral llireclor udJress
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' Signed 'y/�✓ �rrt� �,.ys
� Gibsun Co��y� 4lcaltl�n��sioncr �
Oakl�nri Cit.y, 'In. January LG, !.987
address datc
Recorded luc:�ily in boul; Nu. 11 P:ige N��. 31 t,iled:__7anuar.y l�, 1J£t7