Death Certificate - Sherman, Elbert_10/29/1985RECORD OF DEATH �
�
GIBSOAT COUNTY DEPARI'MENT OF HEALTH
PRINCETON,INDIANA
THIS IS TO CERTIFY, that our records show Fd.REFlI S�I.�1N ��
`�/ 5/ �°RS at ���� P_M_ Forest Del Nursinq Home Princeton, In.
month dsy year honr of death street, hospital, ruial
Age at Death 83 Sex �le Color �1� Marital Statuc �ried
years write whether married or �ngle
Primary cause of death given �eas_ ��estive Heart Failure (sev. wks)
I�-teriosclerotic Heart Disease (yrs.)
Signed by �Villiam R. NTells, D1.D. Princeton, In.
physician or coroner addrnss
Place of burial or remova� I.O.O.F. Hazleton, In.
name of cemetery address
Date of burial 5/8/85 Colvin Princeton, In.
F�neral Director address
SEAL - Signe�l
lz!�F'J�►�r�°�,�,y
Gibson Coanty Health C 'oaer
Oa.kland City, In. 10/29/85
address date
Recorded locally in book No. 1� page No. 145 Fy.��: 5/8/85