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Death Certificate - Douglas, George_2/4/2010COPY OFRECORD`OF'DEATH�ORIGINAL COPY ON'FILE AL'�' IN�IANA STATE�AEPAHTMENT,OF HEALTH�- d�.. - .f �, .. ., �.,..� �.,,� • • _ __ . e�t+o� �� n� �so�s� 'ms.uuon�'r m — . �,,,. ,, ���,. e INDtANA STATE DEPARTMENT OF HEALTH , .�,�,.��.m��,�,��.�. .�`. [.a�l No�Y-.'.t�D.�I �:.... ,.. CERTIFICATE OF DEATH State No . ........................... �---"? if��anasse�su�cai�v�vaikiur.+-ta � ��°'�RINT �.ora�sm-�u�[�w.ars.�..� . . . ' . . .. �.sx s�ocor�n� ao�rtarourHa...o.�i - �� Georgr pouglas Male 8:37 A�..r Prie12, 2U06 � .f c �NO�� � . . . . . . .. .. ,. y ' �my.NENT *.. . �vu.vsrsu.�r•. . ...__ �rw.aarc.�n��a.a- ..s.�.��n � �vmZ; .uavnwun� us.�.w,[cronm+�� - �ru �0`.e... � -. m�e� Ow..er Oaw.iyv,� �� y � ; !V!A' . _ _ . ._ :O a�oe..+ 0 00� m ir.e.e . �. x yn' r s�wrvxuEVr.�uno�sr.dnr.� ' tfm.roMxatOCrnaor�n� r Cou+��aswn� �y ? 3� R R R Yi Bo:36 � � - � - ' � Prineemn ibson � � mN�,., __- = ' -_ "-. . . . , _ SfIN�, w�uwtuSUns i�-6lsmv�1G9d15t� ' �� �hoamertSUSU�oCtVi��n..ws.s� �aoovm�ss,wian�' Gy[/�t Uwal+�Yn��1••-..- . bwN�MOdebC146rrr��0 � j z � � �9amed � tty Jane �iesttall � -�,' �. �: Fa`mer � . • Agrin�lture Q �� �� ia w.vm�-surt ia.taurtr � �r.arv.ra�w(awuna'. -- �m amaruoNtmei � ' � CV � Gibson - �� Prineetou- � � � . �a R al eos 36 . OWR. �mn. �>aWO[� u.��carrurts i.atm:a i�'w�sov.�DO��o�r�vu.tonm.+ iawc4�+...�we.� ��.a�ant[arirw n n m � : IC w O r� �vm,�r tovimm � p w� �O:.a a rw .e�r �'.a.� err wr.. . canr.�s�V.�o.v_mven . mp�.� - . _ .�re.w.e,�ci� a..rs� o�r/so+ra�a t.+wa.as��� � � = , �e�o �� «. �..�� us_a �.b;h �, v _ • o ,: .. - - e - n - '. . NG> - n�ranusw�eviar+��.e � . -. - . ..- " 'nwr�esw+[tFiraai�rans�.r� . ._ .. . _ __�.F m.i�_ _ i . . . � _ .' .�___' . _Zrt. JoLo Douglas �"`�—'-�--.�' _; �-� CoiaM�e`K'ootis-- � -- y � � � � Y _ � . . . - . . - . - _ � T C.��' AaMC1Y:wRNY!<is41w0 .._..{em�W1t�GI.OGRS5L91�NNS�MlO�l4vY.GYate..n9YZaCeO� �IYImMp�.". �. ,m D m�'M-_ Betry• Jane Douglas ._ ''� R R qf�Bor36; Priutefon, IN� 47670 � �fe �y}-` T..��WDOr.04409nW ❑Fwrer� 1�s_wrtbORiC[O�OJDL1qM�N�ree�.,n��v�.a f�c.IOCJ�iqN-C4vian9�'",.--. . � 2' � � s�.er,tl'_ A � 1_�006 c� a; -� e.r . O o�..� O �..e..... sn . P��- . o �„ -- � - - � . � Ft�Braneh L\ _ .. � -. ' ❑ nee �O�a.�.�sdn � Wafnuc Iiill Ctmetery � . '- '- "' �y ' " "' _" _ . . _ '..r;CDf�:~ mPlu�F.EMUC ' . - �lfmta615t��rq - a-w'/�SOUrHiEMlrt(oioCdlUE1a � �`,.��+; J1arkR�Walter - FD01013010-:�, ❑"^. �•� ' n a' - "- vin� :r' o� raa . _ xwurn�aretw awrc�no�uoucv+�naea�orrvauiwie �N `� � `�' ( /'�`\ Qf� �- "'�°"�' Cohin Funeral Homq Ioc, ��FH83005671 - m a � ! ( . - ' ' V �`J _ . �` � �01012933 425'Nort6�Mtiu Stray Princttoa IN 47670.' . �. . > �m; . .' . . _ -ri 'O�i M �� Fiti���M��m�ias�4�r��ae�s�w0eiam��v-YCS�arow�v•v+1 - �� ti����F �uY� _� . . . �r.��i.r�' T ..��� ' +.' . p�D �` _ . - . . , . ..,±.:,- `. _. - a.awo.e� -"., x N � ..m.awaEa..� , Conges[ive tiHeart�� Fai�lure _ _ __ _ n -�p� s�a�a.� . - ourow��st�ara�a.e.cfan': - .... _ • . w p..rm�z IF �a�oaru '. ' ' . x �, . .� • T 'Omy Gsa�w..wai� afm(a/S�W@pH4o�. _ . � .... . � TOI rrewi�O�ur. � _�. . ��_ . . -- m �nA' �y"-°1•+ axromu�•car�asnar�. . w �Oj a p �zi . � .. . _ . . n -i' rurta'dr.v+�cvaw.twes..werai�.mmiue..e+a.r:on�. �rwasc[cEna�r irwi.su+ur�s mwscwiors:worts O� � m m; 1. Hyperlipldemi2 � °'c°""' ° e°`"' reFU`E°' •vuu'°an'°"`° y � NA�; -Z.. $ eriension � � - - °p5i0'"'u" <. >r cwunwac.us - }'F1 'trw e �f OOUTn�r�rti1 t T T � . NQ NO \0 N p�. � i. r. ....._' ' � pm� IsRmf6� ❑CiI�T'MGw�SGr+ iao-id.r�:!o.re�rr.Mi�..dwara�aredor+l.r� Z T � .. IOIS�/I ' ; /S• � - • � . • D �I. ' ❑XFwllnafRLU�h1rev>u�wsu!NN��voe� I+ro+raem�ir�wm.mtio�+�auarer4lrar _ __C.__S=I ar � .. ._ . L ... .: --.a__ . -_:_�-->. '_�— � mm: � �caom�a..r.:> ��w.d�va!n.�ia.a«m.a.a..ra.eaa�..r:rara.a...�.ma�� . m .T4i.! ' � � Mc�EDfY1fLQM ffiU�251��1aW4.M m S�O4ilAFYQTRt101CEM� �. �'o.a . A , _ :) 9pri1 17,_ 2006 m( � ?Zi s. �oo�ssaafrso� uuuea.oun�maiia�ir:.wn^n .- - . . . . . . _.... ,°„ n' Richard D. Hickrod, Gibmu Ca CoronerA?5 � tifmu Si; Pnnceron,�4� 476i0 _.__ �o, _ D.Z.._ 1i..�4tiri0�SSOUM_ .. > � '' � - u wrt/aIDU�woy.rwt � �dD <: - - - mi� s�ua.anur.rn. "»-wnor...w.:Y.-so,nc6. �wa. wom a..otsace[na. ocuwm ' . y.y i q �o.�.nn .:._•: :s+'_. � ' . . - . � Z � � W M✓/ ❑ {Mb�1 Y f. . � - - . ' ' � . � i ❑ Kta� � K.0.AQOfLMl�rtlr�b�Owt�!o+lall¢� ]�LOCJ.idWM�OMYYtii�l\�MiY.Ulsi>SY�I � Q.Sra ❑QV1MY '4l1{sL5{�/A'�..,_.. • � . . Dru� _ .' . . ' .QIh�rW ' - . . - , .. . . . __�.� �y wRMOManimot�ou�swaer�f � w.rDraw�Citattcert•�.�rw .r..ortha..:aev.rr.�� - - �. .' � � April 12, 2006 �o ' � � s�HOe.00e s�sn Form �o>>o �v�-ss� �,( - ��� �r� 1 ` ' , � ivan-zo �i�) ,`�i :r.� ��� � �� ��-_�� 1� � 7 �