Death Certificate - Terry, Roy W Sr_6/4/2009GIBSON COUNTY DEPARTM T OF HEALTH
• 800 S. Prince �.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS ZS TO CSRTIPY �
that according to the records of the Gibaon County Department of aealth,
ROY W. T13RRY, SR.
Died on OS/18/2005 at 9:lOPM.
The waters _
1020 west vine Street
Princeton IN 47670
Age at death . 84 Years
Marital 3tatus: Married
Sex: M
Color: White
Cause of death: High Blood Presure with Congestive Heart Failure
Cardiomegaly, Aortic Valve Replacement.
Bladder Tumor.
Manner of death: Natural
Signed by: Bruce C. Brink, Jr., D.O.
410 N.Main
Princeton IN 47670
Place of buzial Decker Cemetery
or removal:
Patoka, IN 47666
Date of burial: OS/21/2005
Fuaeral hOIDE: Co1viR Funeral HOmE, InC.
S E A L
425 N. Main St.
Princeton IN 47670
Signed by �L„�!/.�tt �� � �
Gibson County Health C�/�� r
Princeton, Indiana 06/04/09
Address Date
Recorded locally in Book No. OS/20o Page No
���'ol
Filed: OS/24/2005
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