HomeMy WebLinkAboutDeath Certificate - Hillenbrand, Anthony_12/16/2009•r�wsrnnn�oN STATE OF ILLINOIS
DISiR1CTN0. `I �. SJ I CERTIFICATE OF DEATH
LOCAL FILE i
NUMBER
1: DECEDENTS LEGAL NM�E
'Aathouy
� couxn oF oenn�
il CRV OR TON?! _
MO11Lt C8Im01
S. 8111enbraad
5�. AGE AT LAST BIRTMOAV (Yaai� 50. UNI
87 M°'°°
ff DEAiH OCCURRED IN A XOSPRAL
❑ Wev� ❑ Fnw9��pm�Afs�M1 ❑ DeaamMira
B. BIFtiXGLAGE B. SOCIAL $ECURT' NUMBER
�@y1q9lafatl�CoWy�
Gibson Co. IN
`.\'�4vr..�itid�C>Sr.�.WA� i . / ♦ AN.w '/Y:�TLti'��"M'PL i
STATE FILE NUMBER
Pebsvasy 3, 2009
April 1, 1921��
I7E. MOSPRAI OR OTMER INSTfTUTION NAt.� W���.."K. VA
Oakview Heighte Coatiauoue Caze
7c vuce oF oE�n� (arumNeec'e.aia�cwss)
IF DEATM OCCURRED SOMENrt7ERE OTHER TMPN A HOSPRAL
❑ MmO�+�' � �7�b91pmusfffi/ ❑ �eeeEa(iMro
10.1M(ifTAl STATUS AT iWE OF DEATM 11. SUPVMNG SF
❑ NTbE ❑ MaibEbA6lN'� � KSEOYeG �Tb•0~R/�
❑ onvrcee ❑ NeMrua'i�a ❑ �wm.n
webneh �IL �62863- �Paul 8illenbzaad
Casmsl
❑ OEr1�Yk
�es wv.+E +z. e�a w us-
xbtrpernape) ARMEDFORCE
� Yn ('� W
951DE CT' LM1T�69
� Yr � No
15. MOTHEfi'S NAME PRIOR TO FIRST MARRIAGE (tist W441as0
Blizabeth Reidford
�. iW.WFORWWTSNPME 16C.REUTIONSHIP 1&.hWLINGADORE55f�+�ro,�'aranstse.mwa)
Joe Harrie Nephea 233 Saet 2nd Stzeet, Plora, IL 62839
77.METXODQFDISPOS(710N:�� 18.PLACEOFDISPOSRIONplarerlmieery,aaamy.aCer) 1H.LOCATION-Cf7Y,TOWNANDSTATE 20.DATEOFDISVOSRIONP��+
0 ph�� �� �� Highland Memorial Cemetery Mouat Caxmel, IL 02 /OS / Y009
�� 31�. FUNERAL MOME NAA1E STREET AND NUMBER CITV ON TONRI STA7E LG
� Short-CliaaingLam Puaeral Bome527 N lSUlberry St. Mount Casmel IL 62863-2097
Lazry D. Hodgson
03{-011192
z - s-fl 9
CAUSE OF DFJITH (See inaWCtlorm and ezemple3) -
N: 7MT I. EftlM ItM flieln d mtM • Ebenas. Yf/� a cand�� - Rut Cvx1N nwM Ne EmN. UO NO7 eNx trm'vul evaVS wU� m wdiat mml
mp4tlary mnq a�trladx fiMllelbn WCiaA 4w.+n0 �9Y. X IM Cscetls�l Md a Esrtirnia nlrts0 6uem. Pmkinfm'e Diasase, a 7erk'vuan
DemrYle Canplac Wira� in Pen I u Pdl LL DO NOT ABBREVNiE ENr oM' are uuss m� I"vr. Md saAiliaW Wwa tl rrnasvy.
U.WEDIRTE WUSE (FkW Eiww C� �j_,it l�Ll�%� S
d mHkbn nWtyq'vi WaT) "'� �' Uw b(tt w a mmsaerc� a�.
s.vwe�,uy ua wr�a�um+. a �.
IraYp m dn uns 4qa m Nr a �� Oue m(« a.�u�@wnu o�:
EMa IM UNDERLYING GAUSE
(NaeaasaY'h�Ytl+WYtifWWtM �
w�rG� rwlt4p vn tluftp lAST Uw b(a b� tauea+rc� all'
MPRO%PIATE I7fTERVAL
e�er+ oe+ser u+o oenn�
vNtt u. Enu Ww apnmc�nt centlnbna eonvlDUUnp ro tlwN Out roi ntWtvq In Ine u�Cwy'u+p �ne piven in PART I. 25. WAS AN AUTOPSY PERFOftMED7 ❑ Ya B tro
7b. WERE AUiOPSY FlNDINGS USED TO
COMRETE GUSE OF DEATH7 ❑ ra ❑ w
77. DID T08ACC0 USE IB. IF FEMALE: 29. MANNER OF DEATH
coKrniaurerooewnn ❑wa.m�.e.e:,wni:�m„ ❑a.o�,.rm.aees�
❑ra ❑ v+o�ur ❑raaa�cwa.v�.�•n+,uarnae.c� ❑a.w�.r.ana,.r�da.s,eua�.� E! we.r ❑ sr�ae ❑raa�ae.a�e,�ea
�w ❑ u+�a.� ❑wa�wamaw�.+aaann�werx.oes� ❑u,r„o.�,�aqm.menv.n�t�mn ❑ �O°� ❑ �°,�de ❑ v.,monwavm,
30.DA1EOFWUHYpbm'Dqlfer) J1.TIMEOFIWURY 33.PLACEOFINJURVI>4�������:�K��� 33.IWURYATWOfL
❑AAl ❑
WURY Statl iNMrtOs
lpaitreM Nwta
I ❑ Ya ❑ qo
$t� ➢P Coae
35.OESCRIBE HOW INNRY OCCURRED: 36. �F TRANSPORTATION INJURY, SPEGIFY:
❑ �� o �
❑ Paemper ❑ OeerlSparin
37.1(DID) (OID NOn ATTEH� iNE DECEASED O�bTDa1�"e+l gg, y./p5 �¢OICAL E%AMWER OR 39. DATE PRON WNGED (Ma@JDeylYer) �0. T21E OF DEATM
ANDlAST6AWNIMMERALNEON% �� CORONERGONTACTED9 ❑Yn � W 02�03�2009 �4:30 OAM. ❑P.A
�1. CERTFIER (Ctrt)c oNy arg
E1 PnyWn m cl�am d w�'. u�e - ro u» om� a mr kno�teew. aaw� oauraa a,s w uie rn+ae(.).na memsr ue�ea.
� P�y�icai In aCVWro et Wn ot OeM oNY - To tlr Dsq d^H ���. bM owrreE tl tla tirtr. Ms rW d�. W aw m Ns �ns(�) aM mrrw aeteC.
❑ MWk21 ErbrvnerlCaors - On IM Dbu ol eraiNnetim eM/n ime=iqetim. in my W�^. AsM omared eI IM WM. MM W Wace. W de to Ne awe(�) anE meN�er qeteE.
62. NAAtE, ADD(tESS MJD ZIP LODE OF PERSON COYPIEIiNG CAUSE OF �EA7N (Item 24) �d. PMYSICIM75 LICENSE NUMBER
8. H. Jani M.D. 1106 Oak Street, Mt.Caxmel„ IL 62863 036-067875
M. TfRE OF CEHTIFIER 45. DATE CERTIFIED PbrSWf�'eEr) �8. SIGNATUR% Op C� IFIE^R^ /
OS-OS-O /��
8. B. Jeai M.D. ��� v"
This is to certity that this is a We and correct copy oi [he oHicial death record liled with the Illinois Department oi Public Health.
DATE Z- S-O �
[ SEAI. ]
J
�ICi%TID � � ��acq0�ifi�
GISTRAR
��• �c �� i.11�,�{�,
DEPDTY REGISTRAR
5