Death Certificate - Corne, Joe R_12/13/2012�'--'°-�"o • • INDIANA STATE DEPARTMENT OF HEALTH ' H 2 7 9 7 7
_ � CERTIFICATE OF DEATH - RESUBMIT
��' �o�� No 001033 EDR No 000000263342 State No 024591
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JOSEPH RAY CORNE MALE 7229 AM 06/01/2012
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DEACONESS HOSPITAL INC
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CAROL SUE CORNE CLEVELAND FARMER AGRICULTURE
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INDIANA GIBSON POSEYVILLE GIBSON CO
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HIGH SCHOOL GRADUATE OR GED
COMPLETED NOT HISPANIC White
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OTHO CORNE FERN CORNE WALLACE
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CAROL SUE CORNE WIFE 17917 WEST 875 SOUTH POSEWILLE GIBSON CO IN 47633
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OWENSVILLE IN 47665 FH89000021
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28. PaM1 L Eam The Gan Of Evefns - Diseasas, 4y�aias, Or Compfnafva - 7Tai D4wly CauseE 7Te OeaN. Oo Not ENU Tum'val EvMqs Intera[ Onsel
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❑ Yes � No
NONE YI. Mhe A�mpsy Fmevq Avaama To Conqh�a TM Cane Of Deamt
❑ Yes � Na
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` ❑ Yes ❑ Na
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CHESTER ROBERT BURKETT BY ELEG7RONIC SIGNATURE � c�nw;rc ar�n� ❑ ca� ❑ n.m,ors�«
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CHESTER ROBERT BURKETT� , 9200 HWY 68 P.O. BOX 550 POSEYVILLE IN 47633 01029806A O6/04l2012
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RAYMOND W. NICHOLSON JR., VIA ELECTRONIC SIGNATURE JUN 07 2012
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