Death Certificate - White, Ada_7/3/1980RECORD OF DEATH i
C�
GIBSON COUNTY" DEPART�IENT OF HEALTH
PRI�'CETON, INDIANA
THIS IS TO CERTIFY, that our records show -'�DA �.�IHITE
12/lE/79 ar 12:SOPNi Holiday I✓anor IJrsg. Home Princeton, IP1
month day year hour of death street, hospital, rural
Age at Death 9�' Sex "e' _Color ��Ih' `iarital Status �'j'
years �vrite �ehether married or single
Primary cause of death given �vas Acute con�estive heart failure
Signed bp R. �'. i,•IPl i'�P� � it4. il. Pri n�atnn, Tn�l.
physician or coroner address
Place of burial or remocal N�t Tabor Hazletor.. Ind.
name of cemeten• addrz,s
Date of burial 12�19�7° Kendall Princeton, Ind.
Funeral Director . � address
SEAL
Slgn2 � `�"�'Z GI. ! ��%
. Gibson County Health Commi ner
Oakland City, Ind. 7/3/80
address
date
Recorded locally in Uook No. 9 Page No.�—Filed: 12/1��79 _
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