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Death Certificate - Williams, Chester_8/21/1973i i ---.v--_- .- f- -�._..-- --- ---.-- --.-._ - ._. _ - _ _ _ _ _ �. _:: _ -�-- - - _-_. : - , .- . : -- _. - -. , . __ .._ _._._ _ . -- -- _ -. . . : -- - - - - - -.: . , . , ----,:._ . - RECORD OF DEATH ' - ��_, .'�- __ . _ � , . . ' __. ' � - " -- GIBSON-•COUNTl'.-DEPARTIIENT OF HEt1LTH ' �''-- '' _ - . -, -:i�'.;�•----` -_i.�.:::; : ', PRINCETON,�INDIANA_: -- .. _ - -._.- - � ._..._ - — - � ` �.�� - .�,. :i.. . - .. .. .' . ;-� - . . .. _ .. - -- ; c �s�Fa��FL�Tcu�?i^4iILLI=��s' - �- ::,r.;.— 'I'HIS:IS TO CER'T4'1', that our r"ecords show - � died - �, r . __. .... . , .� �... •.- � -- _... _. .---., - ' _�,o y�6�..' ��.,��2�4�9'°:- ;Gib.� Gen. Eosp _ Prince�or., -Ird. - - Lcu•-iv __ _ _ - - ..' i � month '. day - :year=. ; � _=: hour ' of death _. : q : 'v.:: ; ,, -'_-: ; -' - = �street,-. hospital, rural. :: � "__:: "_-. �`. - � -' � � 'j_.._• .. _—i °_ .i — � — �il : ' — �i: ._..il—' - — ..'�Age: at Death �.�Sex . Na � P Color—' Wh! Y� Marital Status �: "�T3sr.iP� ' ' • � . .._ �: _'�... ' _ . -..a (:Years.._._ .� . -:_.: j � _..:.: c _:_:::._.� ".:...._ .�-:.:.__�:' _.. • � wnte whether mazried or single . " `j;'—'i -- ' . — -- .:,".."' — --:.i: . —` '— .. �i. — . ' ' . ... :". ..��.,..''. :. . . ,: .. . � "_.��._' _' ".. ..._ . _ . . . . . , .: .. .' , ' Primary cause of death given wa� Rv�ostati c"oneunonia -' =� -' - �_._ . .:;i..-T . ; _ -- ==��_'" - - . --- -- ..,,_ . , . . • ..: :�_: . .... —.�'r . ' ..�..:.� _.. ... �:�<'.��. .�, � � :3.�... . , — _ • __` _ 11 ':. ' ' , '' ' i._ . . '1: .. , : � _ _ . : . �":1�- _ " . . _ ' � Signed by Vi,rgi l °�r�rt�., r• D•� � Pri nceto?i. 2nd. � ... �.-. :.physician.or�comnez .... " '. " ' �. address . ... . �j--j � - . .-' --!� -.. -- � . ' . '_ ' . � . __ .�_ .,. -• `Place of burial or=removat °P r�vi d Pn � a -- .. �a � i cr o, r.,d '--- � - --.-. - ---' • . - - : name of-cemetery -._ . _ . _ _ . : address �- _ . - _ - . - - - � . . _ . . _ ._ . ..___: ... ... ._- ' - ' . . . "' ' � _,.:.� _: �. - � ,`� � - •: ..:?' ... � . : . : . . . . .. - . . _ . . Date�of burial 12/20/57 ---• -k*ade Funeral �o�e � � Faubstadt Ind. �, - � . — � . . . . - --.. ' �--. :.Funeral •Director :=.- ; - �= '-. �-' address -= - .. . - . . --� - . .,.-y,.: . ,...s. .... .: - � � -- �- . . . .. _ . . , . . ._.._ , _. � .......i'. - ,. ��if . __ ...-.�..R' ' . _ e r . _ ,��._'1 t �1� ; 3 . _ : (-�'f - , � � � , � o �S1 ii . �� — ' . ' _.�/��i�i/ �� %%jT' _ . , : - ,'SEAL �' / 5�� . ' � _ � � � " � """ - Gibson County Health Commissioner �" � �. � �� - +I ��. .� �i .: � . _��:`. ". _ _. "_ . ' 1 :) � � � , ' -. �' ' , . ._: r_ � _ � : , � - Princeton "±rnd�.'=' 8/21/7 - . . �. . ..., r ._-�, -.,-� - -� !�..-,�.,� -.......__ _ }..,.__,.?i.�_ii;- _.address �� - ' :date - ::^��._ _ n _. ._ .�; � _r� -- �� -- - . "'.-' '._' - , - . J . :, � , . � " . , � .. , . : :'. ..._ _ -� � � , . . � >>_ „ , a: <-- - 194 _. --._, :•=12/21/67 � � .. ..., _ �Recordedh6G�ily�Y�;book No . 7 Page I�To Filed: - - -. - , _ fa. � _.:,• _ _ _ . . _• .. .. - - "---. . _ .._ � _ . . _ .....�r. . �,. - ,� �..�.,, . - - . _ �. ,, ._ - '- � ' -'-, ..__ � .. - - - - ' ' - _� --� - - . ' - � . - - . . . . . ".: .:' ",; - ' - __' '--- _. .__ ..__; - -- - -' - - -- ' - ` ' - - °' :_ . : . . . � :.. :. . , . � ' ..' _ � '_,.. - "� ':,. � �;,. . . ..�.. ,.. '. �. ':. . _ i� _. . .. ' -' � . �. ' ' . ' ----' � - -'- �e _.i��-•.i.�.. .o. .-.�-� . .. ,. .. . . . � ..... ..Ii.. --. .� _ ....--