Death Certificate - White, Jack V_5/3/2006.
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GIBSON�OUNTY DEPARTMEI� OF HEALTH
800 S. Prince St.
Priaceton, Indiana 47670
812-385-3831
RECORD OF DEATH
THIS IS TO CERTIFY
that according to the records of the Gibson County Department of Health,
JACK V. WHZTE
Died on 03/OS/1992 at 8:59am
• Gibson General Hospital
1808 Shernian Drive
Princeton IN 47670
Age at death . 69 Years
Marital Status: Married
Sex: M
Color: White
Cause of death: Ventricular Fibrillation and Asystole (immediate)
Cardiomyopathy (4 years),
Coronary Artery Disease (4 years), Old Inferior Infarc
Metastatic Carcinoma to Liver, Fibrosarcoma
Signed by: Bruce C. Brink, Sr., DO
410 N. Main
Princeton IN 47670
Place of burial Oak Hill Cemetery
or removal:
Date of burial:
Funeral home
S E A L
Patoka IN 47666
03/OS/1992
Colvin Funeral Home, Inc.
425 N. Main St.
Princeton IN 47670
Signed by .sC�� � i��uNa��(/
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Gibson County Health Commissioner
Recorded locally in Book No. 12
Princeton, Indiana O1/23/O1
A ress Date
Paae No. 34 Filed: 03/10/1992
