Death Certificate - Woods, Herman_2/6/1986�i
!iGCORD OP llEe�TH
GISSON � NTY DEPA£.T➢i�NT OF HEALTH �
PF2INCETOn', INDIA.IA
PIIIS IS TO CERTIFY, tl�at our records sliow ���'��nrr B. 4�OOD� died
12�20�79 10:1�!1M Gib. Gen.iiosp. Prince�on, In:9.
at
month day year hour of death street, hospital, tural
n� .
Age at Death 6� Sex Iy� � Color ��h � nlarital Status—
years write whether married or single
Primary cause of death given �vas �lcute respiratory failuse
Arun C. 3;umar, I:7D �r.inceton Ind. _
Signed by '
physician or coroner address
Place of bw•ial or removal ��)h=t� r_.hurch Princeton, Snd. _
name of cemetery address
12��2/79 �olvin ?'rince+on, Ind.
Date of burial_ —
F�neral Director address
(,v ��'�� �° ' �,�
SEAL Signed
Gibson Covntp Health Commiss�oner
Oakland Cit;/, rnd. 3/12/82
address date
1?ecorded locally in book \TO. � —Page No. 9�' Filed: 12�28�7°