Death Certificate - Willis, Henry M_8/2/2002GI�N COUNTY DEPARTMEN� HEALTH
800 S. Prince St.
Princeton, Indiana 47670
812-385-3831
RECORD OF DEATH
THI3 I3 TO C6RTIFY
that according to the records of the Gibson County Department of Health,
HSNRY M. WILLIS
Died on 07/15/2001 at 4:24PM
Gibson General Hospital
1808 Sherman Drive
Princeton IN 47670
Age at death . 82 Years
Marital Status: Married
Sex: M
Coloz: White
Cause of death: Respiratory Failure, 2 days.
Extensive Pneumonia, 6 days.
Chronic Obstructive Pulmonary Diseases, Years
Diabetic Mellitus, Old Age, Cirrhosis.
Signed by: Rameshbhai P. Patel, hID
105 N. 2nd Ave.
Princeton IN 47670
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Place of burial Columbia White Church Cemetery �� L ,� �
or removal: ��
Princeton IN 47670 '��L
Date of burial: 07/18/2001
Funeral home: Colvin Ftuieral Home, Inc
S E A L
425 N. Mdin St.
Princeton IN 47670
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GBSON COU��Tti' �UDI70R
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Signed by
Gibson County Health Commissioner
Recorded locally in Book No. 14
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Princeton, indiana OS/07/02
AddiE55 Ddte
Page No. 16 Filed: 07/19/2001