Death Certificate - Wilson, Sam Arthur_1/15/1988ECORD OF DEATH
GIBSON �JNT1' DEPART1iENT OF HEALTH
� PRINCETON, I\DIA`'A
� ��.
1iIS IS TO CERTIFI', that our records show S �10ET ARTHUR ���rr cnta � died I
June 26, 1987 8 7:30 A.P1. R.R.# 1 Francisco, Zn.
month dey year hour of death , sveet, hospital. Ivrel �
�9hite biarried
�ge at Death � 1 Sex Mal e Color Diarital S[atus ar[e whether mertied or single
yeers
'rimary cause of death gi�•en was Cardiac arrest ( 10 Minutes ) Ventricular Arrhythmia
( 2 Years ), Cor pulmonale, Chronic Obstructive Pulmonary Disease ( 10 - j
i
Years). K, Murthy, h1.D. Princeton, In. '
�igned by edd�ess �
physicien or coroner ,
?iac2 oi burial or remova
�--I.G.O.F. . _ —Francisco, In.
. neme ot ce:aemn' address
Dafe of burial_ JUne 29 1 � dall ]
U. $• ep8rtment of Labor,
ALACK LUNG P.ROC.R�M,
SEAI.
I
eaaress
JUL 151987. . /A�/� '� �° ,,�,a
.... Sivned' °v—`���"'
COLUMBt15. S1H1�
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- �.
Recorded locally in book No. 1 � Page
e
� ( Gibson Counry• Health Co issioner
Oakland �cy In July 1 1987 _
. . � � address -� date
, '?1:.:.. . � ! ��„l�, 1, 1987
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