Death Certificate - King, Gary D_1/3/2011c`:°;'`4 INDIANA STATE DEPARTMENT OF HEALTH
'�`^� '= CERTIFICATE OF DEATH
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"�:`��� Local No OO�� S'i74 � EDR No 00000�� 15741 sfarP n,� C
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DEACONESS HOSPITAL INC '
25?3 WEST 50 SOUTH �
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�� Yes � No
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❑ Yes 0 No
CauseOfOeaN (SealnsWCtlonsAnGExempla� pyao.�z�=
29. Pan I. En�er TM Cn?in O� Evems - �iseazes. Irqunes, Or Gomptiraturvs � TTat D'veay CevseC T�a Deatrt Do Not Enter Term"r,al Events In;ervxi: Onsel
Svrn Ps GarCiac M. esl, Respiratay Mest Or VenViwlar Fionilation Wnhout Slw..v'.g The Etblopy. Do Act A�heviate. ENer OM/ Orz Cause On To OezN
A line. FEtl AtlCli�l! ines ll Y.ecessary.
LrmeEUteCause(F�.zlDizeaseOrCOrWi:icnftezJ.:bf6��Dea:n) A ANOXICBRAININJURY <DAVS
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Sequemialy4siGorictions,llMy.leativgioTTaCeuseLisiedOn B. SLEEPAPNEA �DYEFRS
L�ne A. Emer il�s UntlertyinB Cause (Disezse Or Njvy ThallMiatetl '�IXy���'�� �
Th° Evenls ResuCVg In �eaN) Last �, �HRONIC OBST0.ULTNE PULNNAAY DISEFSE 10 YESRS
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0. MORBIDOBESITY _ 20YEHR5
C Ves ❑ ProDa�h [� No � Uninown
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� 30. Npm q:^,o;sY `���^G A�e11aNe To ComNr.e Tne Gaus= d DeaID? � Yes ❑ N<
32. OFemale: 33. Mamer010eaN'.
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SIGNATURE
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47770
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0824/20 i 7
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3 25 2011
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