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Death Certificate - Kelley, Samuel Nelson_11/16/1984f� 1 `± Y • , .;� , 'sj : i: ' � t '. •n . t�.. r r. -i: -'�' i R . ti _ RECOItD;Ob�DEATH - , � . y t f . _ , ' � ,��` � .� ; � f ' a � �E' �' .GIESOV COUNTY DEP�RT\IE�T OF�Er1L9It �1�� `?¢�:. `:: - ��s. - PRINCETOy, INDI.1\A -- ± . . -�: n. � ,-. .. ._ :_ � _.' ^_ . ' c� . C^�� ' • �' • ��' .-. ' : ' ` � . .THIS IS TO CEP.TIF,Y, thlt4our iecords show S�lUB� NEL&ON KELI,LY ;.._____ y ' _ e . ' ' {1� y - - ' - _10_L5l$9 �- {,__at �' 10 • 30Ph1 _ Crestview_Ur_,_ • O�•:ensvillc, _ I�n_. _ _ .- month day: �- }'ea � chour of death . � slreet, hosp�:al, ivral .'�•'. ` ��E .� c , . ." - . � '. '^ . Agr at Death- 79 __Se� 1. Cotor j•�h . �Iarital Siatus-- — -- ,. - . «�ra� -�a��...n�. ..._ . - . ' ' �..SCa13' . . • - , . . ' . S' : , : k,� � �' ^biedullary failure ------ - - Primar_� cause,of death ,Q��en «a, -- -- - — ' � - �' ' _. ; _-- �---- '----- — --:------- � � ` f� Signed b� �._ Glenn O. Dickenson, D.O. Ocaensville, Ird_._ _ _ � - '+� �' r�_ ph�s�c�an or coroner�_ . . �. . , . „ . addre:. .. _- a �• � � :i, . . . . j ,,- .. .. • ' � �.Yiaumee � Oeaensvillc, 7nc�.' ' �P!:u�� !' huli�l��vv. temotll � — � - --- . -- --- — . . - . - � " - �� name of cenieter} � - � . . - . �'�� '-` ' z �' - r Gc,ens�;i�" �, 10'/8/84' � Holcer s __ _ _ _ Date oi 1 un �l . — — ' --- -- — — , lddr s � -- , - � nrneral Director � _ . � . , � f� . ._ . . . � . 1 . 7 ' i ' /; � r� . .. �� '/�: . y ( . . n � � � �' . �: - . . . . . /�''� .o, . , �:�. . � _ ' .. c , ,�' ` `� � � � . .. -- 5P 1I .`• - 'Signect-- —' — — --- � fi :a • . �i , Gibson Coi:ntc H..i�ili Co.ui.t_� � ._. .l y 4 � .. . . / _ � - `� 's ' � ` , .. � ---'Oakland City, Cnd_ t('• � : -S . . . audc,r5 . . . . � - ., , .: _ . . �l. � _ :�... r .` _ '. F ' 2 � � . . . �� , ' ` Page Nn. 1�3 � __Filr��i �_ 10 / ?.1 / `3 9 t ger.ordecl bc511} in Lon!. \ro. — - � �_ . _ : . . - � :; � ` %':� '" . .. . . - � . . .. _ . �'�'r-� ' :� -' - ----"---' - -- --� - . + .'^._ --_ ' ' . .. . _ t F >�: �. . �. 3 - . . - . .. + . � t - �. . ;�.- t �. . . . - ;i _ � � .. e i: � ,. . . . _ - . - �� _ . .. i � x- a r r � 3 �:' x .' . _ . t . . . . : . { f � . v � s� - . .. -- � . # . � �:� �:Z � . .. �. ' � - t> .�. x. .. .. . " #:_: � � .. . _ . ' , " , tc. . � i?-. f � _ i: � r . � _ . . . . . � t � 3 �j' - � ; 1i r :`t - fi'_ . - � ' � - . . =a . .F -�" �' . '" _ . . ' ._ .L . . -. . _ _ ., . . .. . � ' _ __—__'._.__._ :,,��- ' i� ., �{;, � �i .� � :.�1 f; � r. : �• : t- `�: , t _`. i. ( �. -:. i . i `:. y��: .� ;! '. 1?` -1 �., � ': � '`s ' ; �' R . � � - �; _, � - 7 'f °< ':i v. .'. . . - �� ' � ;. ' Y �: �ct�i�� PPI� � . Uhi81i1l�IPIlI1tiP �[itlP55PTI1,; Th.it James Harve;� Smitn e�d `!siz�l � zErne'§tine'nSmith,husbead and vrife, and r,len 0. Dickensor a-:� �Es:theP�Jane Dickefison,husband and:�.�ife ' Yc .l� -.;� i . _ . { ' �� Z 4 � ' . � :��if . � ' . ' � 4 �f . i� '. . . . � i:. , . . .. . . . i .. ;y; t . ., - ' . � _.':y ; �.N �.'.;. . -v. : :. : . : . � ., � .. �; � : =� , � . of.: .,; Gibson � i.,� County, in the State of Ir.diana � t :: . .�[. . �� , _; ° ,i' . . . . . . . . Conir.y'dndlf�arraittroi `Samuel N.K_e1�e5 and Hezel R. Kell°y�l?usoa?::t �-.:i W1}'e i - ' '' . .. - ra: .: i; -, � . � "' '' . � � . _ " of- ::ibson� " County,-intheStateof .' Indiana .I'��r.wdinc,��c:�t;r;:;:", �-' �of� one doller end other considerations ''"''°'= �the receipt whereof is hereUy ackno«9edged, the follo�sing describeci it� �:l li.��,;�: in `i ''?�^vibson'. County in the State of ]ndiana, io-«it: k .. ;�r.ot nnr„oer 10 ??illcrast Add!tion,to t'r,� Tor:n`of 0::-,r:s:�i._i�:,. :ilr�ili8^� r _ i �- �° �f�- p,A �•i . . �`�:/. . '' � � 3. , :?.ay ".� ' ..�.. . U . _ j'_ � {i�� ,` p'4 �._. � .. �/ '� �' , 1 .�s �� •,+� � � � �/�1 � . �: � i �" � � I � , . � . i. �1_a8 GT3Iet�8E �=_5f QCCE'UGaIICL' v`� tt1i� ic �i�cU'I::Pa,!t t;::a :s. '_ to tie� bound by the terms and rastrictions recor•.'�:: i;. ,ro , � 152;:oage=186,h1iscelleneous records,office cf t�:.� ��c,.,'+=r:l�r �. s -R,. , Gitis;on.'County;+Indiana. . ; ;, �. _,�.: • ' . %� ��. '° . . ��. :�; . � ._. .� -_=�• - -- -- ° ` , ,�:,.� . T ci!ara G-aes 1nco:;e �a�:.on ; _ ,. . . i S21e.o� Rea� �'s;:.ie � � �-, ' . . 1� :.Pe'd by "_ � � :, �, ' , ; , GA. � c: 7- � . : � . { Granto_ . . ^"Date ?a �d: �-- i __ _` . �' " ' _ - � . 7 ; �' , a ... .. _ _._ ._. '({ID0117i� Y31 d ,._ % S ' _— ' . Treasurer's a��ztpt ;; 6/a�o-611i1. _ : I , C16'cor.'Go�::ty61��-�i1i3 . -. . . rsesr: - �ereo , ISe said: J�ames . }ia^V Ey �ff:l L?: _ ;d .:. _.:. ' .. -..-_ - _.. -" `Smi'ti;n;nusoand�,and wife�and:Gl�n 0. illc'.censon en�� =:s��,a%�a::° .,'_ �:Jickensoriyhustiend and n.,ife - . � .. .� .�. ,N - . _ , . , . . ' . �� _ ' 'i `t � : - Src:i :'._.;; . �.. �" ha�eliereunto set t.nair}�nnd9 and seal a, this . d:�y ��i : . � - s A +: � �� %'�i2v�' _� Jlen C Dic ,��, * - �. n �-i� . ;r', ' ,.. `�i s � r � �/) '�.�' li�ZS?'�{ son — � . . e �ickenson � -(Scal� ��-' %c`• �"�•��'rn' � ,. �V l -.=f/ ,c�i � -iG, : � � �ames .?iar:��v �i.i �i, =(Sexy �--- --- ----- -----_ _ ' , ., :> .f Y� _(Seal)�. ��/"`� �i � .� ��' i: ,. . - _i,.n::;r . hBZ��%.T'11c"'ctjr?E .�.f._r.. ' F, 181:f:5 '::il _ ^ -� . �is irstrumen�_pi•ace.ra:r b3----= --." ` - "''i n � i �. � �_ 7� .r � ..� � i� i��sF �, i + � � -' 5 1� F�� w�"%�� _��✓� Y' �—� � �— .