Death Certificate - Staat, Raymond_5/5/2000� �
GIBSON COUNTY DEPARTMENT OF HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
TH25 IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
RAYMOND C. STAAT
Died on 03/29/2000 at 7:27PM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 75 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Cardiac Arrest (minutes), Atherosclerotic Heart
Disease (years), End Stage Renal Failure on Dialysis,
Hypertension, Arterial Fib
Signed by: Rameshbhai P. Patel, NID
105 N. 2nd Ave.
Princeton ZN 47670
Place of burial Columbia White Church Cemetery
or removal:
Princeton IN 47670
Date of burial: 04/O1/200G
Funeral home: Colvin Funeral Home, Inc.
Y'�`%��yT�_s. 425 N. Main St.
..: . - �_ Princeton IN 47670
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Signed by
Gibson County Health Commissioner
Princeton, Indiana 04/17/00
Address Date
Recorded locally in Book No. 13 Page No. 115 Filed: 04/04/2000