Death Certificate - Lutz, Jack Ronald_10/11/2011INDIANA STATE DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
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515 SOUTH MAIN STREET
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HIGH SCHOOL GRADUATE OR GED
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� Yes ❑ No
❑ ves � Nu DOYLE FUNERAL HOME, 520 S MAIN ST PRINCETON, IN 47670 FH10400010
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ARRETT W. DOYLE , BY ELECTRONIC SIGNATURE FD29500009
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A L"rre. A00 ACC:tinel L"mes tl Necessary.
hmeCiata Causa (Fir�al �iseaze Or Gontlition Res�flvp In Dearti) A INTRACEREBRAL HEMORRHAGE DAVS
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❑ Yes ❑ P�opady � NO Q Untiqxn
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❑ Yes ❑ No
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IVRA-20
(7/OS)