Death Certificate - Lloyd, Jeffrey lane_6/25/2012INDIANA STATE DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
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805 WEST SCHOO� STREET
19. DemEaVSEEUm�m
HIGH SCHOOL GRADUATE OR GED
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Cause OI �eaN (See InstrucUans And Fxampla) . ApM��^e�e
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28. Part I. Entar TM Gtan ��s - �iseases. Iryurren. Or Complicatias - That D�ry E1iol� Do No PEbeviate EE�rter OMi One Cause On To Death
Surl� As Csrdis Mert, Res Artesl Or VeNriaAar FiEnOation NAnwi 5hvxng a9Y�
q �ure, AEE AtlEtinal Lics H Necessary.
A GAROIOGENIC SHOCK ONE HOUR
4rvneCUro Ca�se (FiW Disease Or Catl¢ion Res�Atlrg In Oea'h) a,,,,�a.�. ��.,am �
8. MYOCAR�IAL INFARCTION ONE HOUR
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L'na A Enlar Ttie UnCaycg Cause (Diseasa Or 4quy TTat 4Niated UNKNOWN
iTe Evmis RavA:ig In Dea'J:) Las� C. GORONARY ARTERY OISEASE
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31. OiE Tmamo Vu Caun4ae To Dean? J3. i� Fertwe:
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R4LPH JACdMAIN, VIA EIECTRONIC SIGNATURE
❑ Yes ❑ Na
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138A 03I26I2012
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MAR �7 2012