Death Certificate - Earles, James A_2/14/2013 '°_"a' (ANA STATE DEPARTMENT OF HEA 1017540
CERTIFICATE OF DEATH
. `try] Local No 000045 EDR No 000000303006 state No 003535
I.Deadenrs teal wme(FestiAwe,Lasl I la. Mass Name (dferale). I 2.Sea 3.Tens Of Cer 4. Drs Of DCa-,P:en/ayne.
JAMES A EARLES r 1 MALE I 07:44 PM
I
in V.S.Armed Forces' 110.a Dean OCmned It A Npsxr 1 1Da
If Dean OavrteG SPnewnee Omer That A Hobble
V Yes ❑NC Unshaven i®Inaa-en ❑Emergent,Depatnert Oubaeett 0 Deb On Arrive o❑OMecDS C R F ❑DeeaMfS'lc" ❑Nvtv,9 Hornet ierm Cars FataS
y
11.FiCATY W Y In N01 Ie6.1906.Give Steel and Numael
DEACONESS GATEWAY
Si Cry Or Taw..Stab.meua Ccae U. County 01 Dear. It Mortal Sams At Tune Of Dead'.
NEV/BURGH, IN. 47630 I WARRICK 0Wlao+ec O Never keened 0Unerrms
IS Sunswg Sonne's Name Isa.(If Weelv,.e uaaer.Lill Name 16. Decants Usual Otva.an 17.rind aease65,nasay
KAREN EARLES MILLER FACTORY WORKER MANUFACTURING
16. Remaence-Stab 1 Ma Coon. 16o.Cey Or To..s.
INDIANA 'GIBSON OAKLAND CITY
I&. Sam And Mama
lad. ApL No tae.Zed Coe* It Inside 6ty Lima?
11579 EAST 200 SOUTH 47660 0 Yes 3 No
19.Decedents Earatbn 20 Decedent a rvsoanc Cutlet 21 Der+pnms Race
9TH- 12TH GRADE;NO DIPLOMA NOT HISPANIC i White
Z2.Fmners wore Ism.Kaye.tall 23.Moth's Name(Test MLdde.Las) 23a.MoLYh Masea Last Name
JOHN EDGAR EARLES MABEL EARLES ,ALSTADT
(24.alormarrs Name 24a.Reaorcsne To Decaoc4 24G.Na4q Adorns (Steel Ant N,Rlee,OM1,Sate.Is Cote)
KAREN EARLES SPOUSE 11579 EAST 200 SOUTH, OAKLAND CITY, IN 47660
23.Rate Of Dtspwtor.
25a.Mace 01 De000non 25e Race Of Dspnrn.(Name Or Cemetery,Crematory.Omer Puce) 25c.Loosed.Cay.yawn.MO State
0 Burial ❑Gannon ❑Gannon❑Enbrbment
❑Removal Fran.State
❑over ISoacryk SOMERVILLE CEMETERY SOMERVILLE, IN
26.Wes Coroner Consenter 27. Name And Cyfdele Aspen a Funeral Fabmy Dyer. Funm'u,t Liteme wrtCU.
fly 6 NC CORN-COLVIN FUNERAL HOME. INC., 323 N. MAIN ST. PO BOX 278, OAKLAND CITY, IN
47660-0278 FH19400002
270.Sgtuwre a mart,F s Service Lwvee: •]c License w.Der(Of tenses
MARK R WALTER.BY ELECTRONIC SIGNATURE FD01013010 --
Cause OI Dean (Sae Instructions And Examples) Mdretimae
25.Pan I.Erie The Cien Of Every -Diseases.W4anes.Or ConpscaDo s-The;Darcy Caused The Dealt..Do Nor Enter Terminal Evens LTtervat Onset
Sum As Cardiac Most Resoiabry Mess Or Venmaaar Fmrlaton WNW Showing The E•,obgy.Do Not AGhrewate.Enter Only One Cane On To Death
A Line. Add ACdianel Liles It Necessary.
Immediate Caine(Fnal Disease Or Condoms Resuldm in Death) A. ACUTE MYOCARDIAL INFARCTION 10 DAYS
r...in A. w.-en
Seouentlaly List COnanass, C Any,Leading is The Cause Lima Or. B. d.xta...r.........-tn
Line A. Enter.'The Unoersyirg Cause(Disease Or Inµy That Ineiatec
The Events Resubng In Death;Last C.
w.In A..[--.-eon
D.
Pan II.Enter Dow Senecanl Cp avers Ca';tutna to Dean Bn Not Restteg e:The tm0emag Case Gmn in Pan I 129. Was An*mops)°clammed? D Yea 5 No
ASPIRATION PNEUMONIA 130.wee Autpay Feldg Araeage To Cmekle Tile Case a Dead? o Yes C NC
31.Dc Tceamo Lae Connh2 it Dean? 32.If Feriae: 33.Manner Of Dean:
❑rn ❑Pmoatey ®NC ❑tx ❑"•"Neva ram e..... D..e. AmN.ot.. 0..Amineti'- -.e....t r...m tom. ®Naecrs'0 rmmaae ❑Aral 0°erwg m.emarmn
❑, rPvw 6•4m46-...1.6.i4•mune.'r.., ❑uem••••e».wNa es,n...n., 0 Suoae 0 Cart Not Be DeummC
34. Date Of Ity ay(Motetal✓reae) 35-Tex,
TaY 36. erode Of Irryry(E.G.,Decedent's home,CaSIItRCn Sc .Restaurant.Weeded Area) 37.IMxy Al WM?
36 Lmann Of Injury DYes ONo
fury-State 36a.Cny Or Town I 38d. Epee:6 Number 36c. ACC Na. sea. Yp Code
39.Cesotoe rue moray Occurred 40. If Tnuporata:Inury.s a.
p.-.. .emu- t
IT Wage. DI Pelson Gees'ye:a Cause a Deer::: 42 Ceti*,ICnW Only Dr.)
!MARLON DAVID JORDAN. BY ELECTRONIC SIGNATURE 0 Certnrug Pnstan ❑Corona ❑..eo,Dicer
1 43.Name.Actress And Lc Cox C`.rrsm Ceteryeig Cause Of Dear 44,i¢r¢e w.neer A5.Drs Cretin
MARLON DAVID JORDAN .4007 GATEWAY BOULEVARD. NEWBURGH, IN 47630 01030224A I 01/23/2013
46.Aoa'taia Funeral SeMCe Prppr I 47. 'Altars:
48.Ware of Local Heath Dicer 9. For Regbbe OMy -Dart Fdec(Mpr?IDayhu'S
RICKY B YEAGER,VIA ELECTRONIC SIGNATURE I , JAN 24 2013
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) i
I
State Fern 53355
IVRA /mTTENTDN ESTATE:The Socal$eGQRy a b De:'I-y reGllealW cy Ulm Stale agency YI order la eufSU!Iesaet5Ei4Y. L7slyailxp 6 WRIn'iy NC there Ma be to penalty(y rlAial.
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