Death Certificate - Albright, Matha A_4/16/2012Local No
INDIANA STATE DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
PALMER
764134
100 �r� oan �rs �W.� O6/23/1911 PATOKA IN
9. E�er in U 5. ArmeG Foetts? io. n oer,n ov ,«e m � now;ue IOa. t! OeY.� OavrteE SaneMive ONC Tl�an R Mosplal
❑ Yes � No ❑ Untnv.m ❑ �npaoent ❑�GKe cafdry ❑ oeceaenrs Mome � Nurshp Iwmetag-tmn Care caoSry
❑EmeryuryDepavnentOU�.paaent O�eaEOnArrival �ONalS�N)
FRAi�1E RGAD
:eaenrs Eaaum
SCHOOIGRADUATE OR GED
JOHN J PALMER
❑ Bu� � C�emawn p omxim � Enmmoment
❑ Remwal Frwn Sla:e
❑ om« �soeo+rk EVANSVILIE CREMATORY
❑ ves � ruo
IN 47670
012153
28. Pan L Enter The {l+ain Of Events - Diseases, Iry'unet, Or Como��etions - TTaI DireCty CeuseC TTa Deaih. Do Nol Enter TermWl EvenLs
Suc� As CarEiac Artesl Respi2tory Mesl Or Venmwlar FbnPauon W thwt Showing The EUdogy. �o Not AEbreNate. Ents ONy One Cause On
A Llne. AOE ACCi:i�wl Lmes It Necessary.
Immediate Cause (Fnal Diseese Or ConEiuon ResNSng In DeaN) A. DEMENTIA
ei ..w�...
Sepum�aly Lisl CorMi�vis, H My, Lrativg To The Cause Liste00n B�
tine n. Enter Tl�e Unoerp'vig Cause (Disease Or Injury Tna� Irvtla:eE °i�bj6'�•�°"P'�°
The Evenis ResN;ing In DeaN) las� �
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0.
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❑ Vas ❑ NO
AppmAmata
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To DeaN
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DANIEL J. NALIN , 1750 OAK HILL F
a6. N06".io`W FunmlSeeWx Pro-nec
IN
ceM�er (cnadONy
p ves ❑ No
a'[y«.".�., po.-�s.dn
Co�oner . [] Hea9i OfXu
MAR 16
L. i
Stata Fam 53395 qT7EMqN ESTATE: itre SodalSecainry n a Onng reC�este0 by I�is state agenry in ader to Wrsue respon5iDi4ry. Discbsure is wlunary anE Nese wi71 �e no pmally fm �dusa�.
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