Death Certificate - Whitacre, Omer_9/15/1976'/
RECO2D OF DF.ATH
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GI};SON COUNTY DEPART\IENT OF HEALTH
PRINCETON, INDIANe1
THIS IS TO C�RTIFY, thlt our records sho��•
'-.�: 9/3/19?6 at � Good Samaritan Nrsa. Home Oakland
'� month day year hour of death street, hospital, rural _
Age at Death °1 Ses—_M_. _ Color�k.Ih�+Narital Status �`arried
}-ears . write �vhether married or single
Primary cause of death given was� Gona FPart Faj,l„re
OMER IJHITACRE
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' Siened b}- Wm. E. Dvr. !+ti) naki�„� r�-�
. physician or coroner a dress
Place of burial or i•emoval Haaaie nPxtrr,�+n
name of cemetery address
Dnte of burial 9/6/�.5 ldatkins & Sons 301 N. Walnut Dexter, Mo.
FLneral Director address .
SFAL
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' Signed
GiUson County Health Commissioner
Oakland Cit,y, Ind. 9ii5/�6
address date�
Recorded locally in book No. �-52 Page No.—�Filed: 9�14/�6
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