Death Certificate - Wise, Grant W_6/3/1987RECORD OFDEATH . �
GIBSON COUNTl' DEPART\IE\'T OF HEALTH
PRI\CETON. I\DIANA
THIS IS TO CERTIFY, that our records show GRANm �d L9TSE died
.•tav 19, -19R7 a� 4•d0 P hi 614 N Ha � St Princeton. In.
month day year hour of death street, hospital. rural
Age at Death 83 Sex Male Color t^ihite �.tariial StaWs Married
��e�s w�rite w-hether married or single
Primary cause of death given «as Acute Renal Failure ( 24 Hours) , Chronic Renal-
Failure ( 2 Years). .�
Signedby j`�illiam E. Dye, b1.D.
physician or comner
Place ot buria] or removal I.O . C. F.
name of cemetery�
Date of burial h;av 22 , 1987 C
� Funeral D'vecror
S �t�.
Oakland City, In.
address
Princeton, In.
address
lvin Funeral Home Inc. Princeton, In.
address
SigneLL����r' � �y�'�-! --
Gibson Counn� Health Com,rty!ssioner
Oa}:1and Citv, In. June 2, 1987
address date
Recorded locally in book No. 11 Page �o. 38 Fi�
iday 20, 1987