Death Certificate - White, Lester_1/29/1975'�. .. . . . f� � . ,�_
RECORD OF DEATH � i
GIBSOAT COUN'I'1 DEPART\IL\TT OF I3I�ALTII
PxivccTO��, t�ni�xa
THIS IS TO CERTIFY, tliat �our recoi•d; sLo��� L"S'i• ;.r, *{ �: r�_ died
Jan. 7.4, 1975 at 11:2;°.�rt�' !?ih. ��n. -os:,. Pri��t�n T.,a
month day year hom• of death street, hospital, nrnl
Age at Death ;� Sex �'a1-°- •' Color '+P=t° _lfarital Status N�r�'-ed
years � �vrite a�hether married or single
Primary cause of death gi�•en was ^`�rn^3r� ��� Tnf'a.-�.1�_.»-.
Signed b}, Jam�G � or.lr r. p„},,,,'r� Tr,;
physician or coroner � address
Place of burial or removal !• O• 0• F• Pr �r..^.=ton. Ird ,
name of cemetery address
� Da/te of buria
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l./7.7/75 Co1Vln F- SOn
Funenl Director
Frinceton, T_nd.
adaress
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If% `,_l,�,� I � /'.1�0
r4:Lo�:4;;.-11,.�� Z
Gibson County Health Commissioner
Frinceton, ind. ]./20/�5
address date
.' ' Recorded locally in book No. ° Pa;re No. 1 Filed: 1 �_'��75
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