Local Record of Death

DEPARTMENT OF HEALTH
ORANGE COUNTY, INDIANA

This is to certify that our records show ____ James F. DAVIS __________ died
___December____ 31, ______1955______________Married_____________57______
         Month                  Day                Year                                   Married or Single                 Age

Primary cause of death _______Broncho pneumonia____________________________

Signed by ___Keith Hammond_______________________Paoli, Indiana___________
                           Physician or Health Officer                                            Address

Place of burial or removal ___Claysville____________Washington County, Ind.______
                                                 Cemetery                                   Location

__________W. E. Ellis & Son____________________Paoli, Indiana_______________
                          Funeral Director                                                       Address

Date of burial___January 3, 1956____________________________________________

(Seal)						Signed ___P. T. Hodgin, M.D.__________

____February 11, 1956___________________________Orleans, Indiana____________

Death Record No. __9__, Page __ 21___, Record No. __143___

(c) 2001 Barb Wise (wisebarb@home.com)