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HENRY COUNTY BOARD OF HEALTH
NEW GASTIE, INDIANA
CERTIFICATE OF DEATH ,
i~-~ r r# i f~ p~~ that according to ihe records of the Henry County Health Department
Name of deceased Olwille H__ hlelhnurne
Date of dearh ~uty~. 1969 at 1?t S. 1'1CCU71 4t r..~„ti*et.,.~, T~iana
(AAa~th) (Day) (Y~ar) (StrNf Hospital or Ru~
SEX COLOR OR RACE MARRIED NEVER /MARRI~ AGE If Und~? 1 Y~ar If Und~r 24 Houn
(In Ywn) MONTHS DAYS HRS. MIN.
WIDOWED DIVORCED (Sp~afp)
Male Nhite 61
Primary cause of death given was Cii~C~lldii~r--~.1YA~" 1''IQtiit.~~
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~ Certified by ~C:lelfd~:~Dve, M_D_ New C~+s~, Indiaoa
` ' ~ ~ {,P~h~ :Jitian or corornr) (Addr~ss
6 Place oi b~'rtal or'remoYq~4 Fellows Cem. Carlisle. Indiana
~ Date of.burid ~7~24~69 Funerai di~r
ctor BUtChel" Funerai Hcrtie KI11q~ tOMll~ Indiana
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~ Retord wqt•filed 7r2~-69 " Boo~~ III 48
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~ issued on March 3, 1975 , ~q_
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