Death Certificate - Usery, Hosea A_6/2/1975R�CORll OF DE_1TH
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GIBSON COU?3TY DEPr1RT�I�\TT OP' IIEALTH
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TIiIS IS TO CERTIFY, that our records sho�v HOSEA A. IISERY died
i�:ar. 30, 1972at 9�25�?� 1122 s. Race Princeton, Ind. —
num.[h day pear Four of death street, hospital, rura!
Aoe at Death %9 Se� I'=31e Co?oi• ?'�hite _Alarital Status i�t�rried
_ years � . mite whether married or sinele
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Primarc cause of death given was Uremla
- Sie-n-nedb�- Bruce 3rink, DO Prin��tpn� In��
� �. ph}�sician or coroner . . address
Piar2 of burial or removal ProqidenCe Franr.iGCO� Tnd.
� name of cemeterv address
, Date of burial 4�?/7? KArRai i F„nE.r�l u�e^_„�---• _a.��rv��o�r_—�:t�—
Flmeral Director address �
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Siined
Gibson County Health Commi;;ioner
Princeton. Ind. 6�2/� 5
. address - date
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Recorded locally in book \o. � Paoe No. 4A IPiled