Death Certificate - Wiley, Jane_12/13/1984RECORD OF DEATH � •
GIBSON COUNTY DEPARTMENT OF HEALTH
. PRINCETON,iNDIANA
THIS IS TO CERTIFY, that our records
JANE WILEY
_�
10/6/81 at 6:20AM Forest Del Nrsg. Home Pr3nceton;:Ind.
month day year hour of death street, hospital, rurat ' �"
.�. -
Age at Desth �5 GeX Fe. ��or �'m' M�tal Status _?,,Married
Y�� � .write whether �married or �ngle
Primary cause of death given was_. Cardiac Arrvthmia �" - -�*
Signed by Arun C. �Rumar. .MD Princeton Ind'}"`� "
� phpsician or'e'oroaer � ' � - - '�address
Place of burial or removaL White Church Princeton, Ind.
name of cemetery addreas
Dateofburial 10/B/B1 Kendall Princeton, Ind.
F�neral Director a3dress
sEaL
�(/'�Y��LICi'.. �.i�i,�%
Gibson County Health Commiesioner
[�akland ('it� Znd. 12/12/84
address date
Recorded locally in boolc No. 1 � Page No. 51 F'iled : 10 / 14 / 81
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