Death Certificate - Yeast, Adah_6/1/1976RECORD OF DEATH �
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GIBSON COUI`TTY DEP:�IiT\IENT OF HEALTH
PRINCETON, IA'DIANA
THIS IS TO CERTIFY, that our records show ADA: Y�4S t died
i �� :
;=*::� Jan. 19, 19�5 at 4i�0:1i%; Wirth ��`emorial voso. (}akl�nd ('itv Ind
�.. =.\- month day yeaz hour of death street, hospital, rural .
�. _;�ai:' .. ; .�.
-•'�`; Age at Death 85 Sex . remale Color'`�hite i�farital Status M�rrle�
" years � write whether mamed or single
„y ;; -.; Primary cause of death given �vas Cardlovascul�r_eollanc
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Signed by GPral� ('r3v � n �aklan��tq,_Ir!�.
phpsician or curoner �- address
Place of bui•ial or remova] `���1 nut � 1� i Ft �� 1�� T a
name of cemetcry address �� �
Date of burial 1�21/75 �todahtll F�nar-� anmP F� � a �h� ��y�
Fi�neral Director address
SEAL
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G";- �` <s� i=C G-. �=�-`�� � �.v
'Signerl
Gibson County Health Commissioner
O�kland Cit�r, Ind. 1/26/75
address date
Recorded Iceally in book No. �'-52 Page 1To. 1'�_Filed:—_].���/7�, �