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~ CERTIFICATE OF DEATH
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lE0 AMO ~•"~OED
~ S7.UI~IE t •~T1' FLA. ~ :
28i~s~3 HANCOCK CQUNTY DEPARTMENT OF HEALTH ROCER s
~ CIERK CIR ..~3~'RT _
~ GREENFIELD. INDIANA afcoR~ vER~~ - ~
~ TO CERTIFY, that our records show C~'. HOWaRD_.CORBI~,~, ,~~,g~,~„',~/~,
~ THIS IS
~ `
~ NOVEMBER 8, 1972
~ Date ot Death ,
zs~s~3
~ R.R.#1 NEW PALESTINE, INDIAN~ '
~ .....................................t..........._.................................................
~ Place ot Death ~ -
55 Sex ~'E Color. WHITE NEV~R Mr~RRIED
~ Age at death . .
Y~ Married or 8inale
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Cause of death given was .............~C?~S?~1ARX..4~G~V,~~A~`1.....~G
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pEW PALESTINE, INDI
~ Signed by.......~B..CAiGLEr...M.D.
- PL~sicis~n or Coroner Aadrea°
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rti,POLI INDIAI~A
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~.i Place_of burial o~; removal.....A~`I+4.~Y?M~~~:..A~?.. .............wderees
=~"y ~ ~ - , ~ Name of Cemetery
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_ F NEW PALES,T„A,I,aNE I I A
Dat~g of burial...~iS?Y...~...1`~.7.2....... #~~~?k~~..~~~ARI;;S
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~ = Funeral Disector d~
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_1o~11Y irt Bo6k No ............................Page o.............
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Director. Hsnooct
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~ ~ ~ ~(,~V f'~t~W Date......~?
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