Death Certificate - Sisson, Willard Berl_3/2/2005THIS IS AN OFFICIAL COPY OF RECORD Of �EATH. ORIGINAL COPY ON FI_LE ATITHIS�C_OUNT(iS HEALTH OEQARTMENT
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MAR 2 2005
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THIS IS TO CBRTIPY
that according to the recorde of the Gibaoa Couaty nepartment of Health,
WILLARD BBRL SISSON
Died on O1/31/2005 at 7:04am
River Oaks Health Campus
Princeton ZN
Age at death . 88 Years Sex: M
Marital Statue: Married Color: White
Cauae of death: Massive Cerevrovascular Accident (1 week),
Peripheral vascular Disease (years),
Cardiac vysrythamia, Old Age
Manner of death: Natural
Signed by: Ramesh Patel, M.D.
105 N. 2nd Ave.
Princeton IN 47670
Place of burial Mount Olive Cemetery
or removal:
Mt. Olympus IN
Date of burial: 02/02/2005
Funeral home•
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Colvin Fluieral Home, Inc.
425 N. MdiR St.
Princeton IN 47670
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Signed by � G �/~G���
Gibson County Health Commissioner
Princeton, Indiana 03/O1/OS
Address Date
019030
Recorded locally in Book No. 02-200 Page No. Filed: 02/Ol/2005
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VOID If ALTERED OR ERASED - NOT VALIO UNLESS CERTIFyIED;BY�HFALTH OEP,ARTMENT