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Death Certificate - Thorn, Omer_7/11/1967
LOCAL. � ' - . - -.._ � ..- _ , . r,. RECORD OF DEATH • ._ � ' ,•= . . .: . ,, CITY DEPARTniENT OF-HEALTH ' ' - � � -� � : . . . � - . . , � � � PRINCETON,. INDIANA• � � ' � . ' ' . .. THIS'IS TO CERTIFY;'that our�recoi•ds sho�v •__OI"LA-THOEN' : ' died, duly � 5 -` : 1967 �_ at3::lOpm RSi�1��Hazleton,, Indiana :.� � � � � � month � . � dap �. � , • pear . hour_ of death - � � ' ' . s[reet,..hospital, rural . . ' ASe at'.Death - 64 Sex Male' ''Color . White' .' Married� �� � � � � �� � write whethermarried or.single . � . �'. ' years� ' . . . . . . _. . .._. . . " . . Primary cause of death'given was '- FTactured Skull ' � � , _ ' - Signed by� gnhert J.wade; "�oroner � Nauhctadt�,. Ind4ana ' "'-` y . .- � physician or coroner ,- ' � . � � addTess . , _ . . - " �- ' , � . " - � , . - ' - . - . . . - . - . � . ' . . ' ' • � i � _, . Place of burial or removalFRirviPw �Pmetery- pinr.Pnnes, .Zndiana - . . � . . . . -'� name at cemetery� ' . . - --• - � . 'address . � � . � . - ' : Date of burial - - • . , . . . � . - . F�neral Director: � . . . - , , � i re s . '���7 - . - ' � . . . . . . . . �'�( T� ' . . _ . -. SEAL- • -`.�,.' � . : '::. :' _ Sig'nerl ' -�_ _ . . qecy;, � ' _. --- . - _- . - " : - � - . ;.Priiicetnn'� �jn�iana'. , 7_11_ii� ; ' - . . .. ' . . . :' ' _ � _ 'address �. . � ' -_ . . . ' . ' ' Date • . .Recorded ,locally in book No. • : - H_ SOPage No. ' . 96 - ',.- - ' • ' . , -. - . . - � Fi1ed. -7-10-67 . _ . . , _ . . _ . , . - �.