Death Certificate - Wuertz, Russell A_11/14/1979R�COItll OF D�ATH
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GIESOI�T COUNTY DEPAKTil1�NT OP' HEALTIi
- PRINCP'['ON. ]NDIAN.1
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THIS IS TO C�R^tIPY, th^t our records show RUSS�;7,T. A, 4+.RtRR'i'z " ° died
11/9I?9 _at 3:3oPM-._ _ 12 s.t'fash• �. Prin�.etnn� `7n.�_
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month �duy year hour of death � street, hospilal, rural ..
Age at Death 75 Se� r�' Color Wh• TZarital Staius— F,7arri a�t
� yeara - write �chclher man�ied or single
Myocardial infarcti:on
Primar}- cause of death given was —
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Signed by Ja�es F. Peck, TY1.D. -Princetan, Ind. - �
. � physician or coroner � address. _ �..
Place of Uurial or removal Maple Hill Princeton, Ind. . '
� name of cemetery � address � . - -
Dateofburial 11/10/_zs— xe.ndall ���neete��3-':
. . . � Fwneml Director . addmss -
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Signed � " L�LC � �� � f�a,rj - --- -
- Gibson County Health Commissioner ��
Oakland City, Ind. il/13/79
� address date
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Recorded`locally in boolc No. 9 Pave I�TO. 91 Filed: 11 13�79 _
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