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Death Certificate - White, Hayward_5/12/1983RECORD OF DEATH
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G�BSON COUNTY DEPARTNiENT OF HEALTH
PRIr'CETQN, [NDIANA
THIS IS-TO CERTIFY, that our records show i�Y'"IARJ "tVHiTE died
i ,
:2/2�/$2 at 4ANi Gib. Gen.Hosp. Princeton, Ind.
� month day year � hour of death street, hospital, rural
Age at Death �9 Sex M' Color 'jh' Marital Status Divorced
' i� years � � write �chether married or eingle
�i Atherosclerotic heart disease
Primary cause of death given was
Signed by
Place of burial or
James F. Peck, M,D, Princeton, Ind.
physician or coroner address
emova� Grantsburg Grantsburg, Ind.
name of cemetery address
Date of burial Z�22�82 Colvin Princeton. Ind.
Fwneral Director addrnss
SEAL
�.t� L���a�nt �° < � z
Signed
Gibson County Health Commis ner
Oakland City, Ind. 2/26/82
addreas dace
Recorded locally in book No. 10 page No. 61 F�led:
2/26/82
