Death Certificate - McDowell, Leo C_5/22/2012,��` "`"o.� INDIANA STATE DEPARTMENT OF HEALTH
�; t�'�'�.� CERTIFICATE OF DEATH
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�,.,� Local No 000020 EDR No 000000175074 State No 001199
t.DaxOe,u'sL�alwme IF✓SLM�OOx.Last) ta. MalOenName OtiaiWe) I.Se. 3. TimeofOaaN a. 6a1e0(OeaN (MOnWDaYnear)
LEO C MCDOWELL MALE 0530 AM Ot/05/2017
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Mospul
p Yes ❑ No ❑ Unknown ❑ �nuauen� Q Emr�peicy Oe�nmmt Ouroa;rem O�«� lmva� ❑��e Facay � oeaUenrs nmre ❑ Nurs:q tfuna4aq.wmi Gre Faatn
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it. FaoirytUme (ItNaInsLWam.GiveStrenanENUmOer)
6824 W. MAY RD ROAD
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❑ Mame� � MameO. &n Sepa2lM ❑ Oivotced
BLOOMINGTON, IN 47403 MONROE �1V°�""� ❑ N�""=^� ❑ �^�^�^'^
15. SuM.LgSpouse'sName t5a. piv�5(e,GrveMaaenlastName 16. OeceaenYSUSUaIOCC�pation 1]. KiM01B�sviey/I`qusuy
RETIREDLABORER FACTORY
I�B. Resqe�re�5ta:e �Ba. Counry tep. GryOrTwm
INDIANA MONROE BLOOMINGTON
1&. So-eel:w�tlNUmOe� 184. AplNO. 1Be. LO�W2 iBt. U¢qeGryLimi6i
6824 W.MAY RD. ROAD 47404 ❑ res � No
't9.ec�..�rs���^__- ZJ.�a:iim:J:hs�anxOrqin it.9ecMantsWx
STH GRADE OR LESS NOT HISPANIC VJhite
12. Fatlwls Name (First InEOe. Lasp 23. I.IatMfs Name (F45t MiEde, Las1) 2'sa. Mometa Maioen last Wme
GILVIE MCDOWELL MYRTLE MCDOWELL THOMPSON
2i.In:onn2nCS Name 2sa. Rela'vmsNO To DeaOent 2a0. Mamnp P4O�ess (SVeet AM M�mpa. Gry, Sta:e, Zip CWe)
LINDA LINXWILLER DAUGHTER 6824 W.MAY RD. ROAD BLOOMINGTON, IN 47404
� 25.PaceOlOic �tpn
3Sa. A!emo0 01 Uspovaon 250. Rxe OI Oisoovt+on (Name OI Cemetery. Gertebry. Oser Place) ZSC loaem � Cay. Twn. Arq Sm:e
C eueai O Gemauon O Dmaum O����ent
❑ aemwai From sn�e
❑ omg �sce�,iyt FORSYTHE CEMETERY OAKLAND CITY, IN
26. \Yaz ta0na Conuttctf? 2]. Name futl Camplete ACEmss Of Finaal Fao4ry I]a. Fseal Hmie Lkense Numpv
� res p No ��1B BASHAM MEMORIAL CHAPEL, INC., 226 E. WASHINGTON STREET, OAKLAND CITY, .
IN 47660 FH83005312
Pa $C�a:ura011nCONFine215emceLicensee: 21c. LicenSeNUm0a101LJCmseel:
JERRY LEE BASHAM , BY ELECTRONIC SIGNATURE FD01016589
Causa Of Dmth (Sae InsVUCtions AeM �amplee)
Approwmate
28. PaM1 I. Enler Tl�e Gnain Ot Events - Oiseases. Iryunes, Or Gomplica4aa � TTa� DvMty Gause� TTe DeaN. Do NW Enter Teminal Evm6 Intu�al: Onse�
SuU As Cardac Artest. RespirdloryMes�, Or Venitlwlar FiOnAaGon Wilpoul5�owin8 T�e E�idogy. Do Not AGtrevUta Enter ONyOne Cavse On To DeaN
A Line. AEC ACE��nal Lines It Necessd7.
ImrtieEiate Cause (Final PSease Or Contliuon ResWGrg In DeaN) A. CAftDIOPULMONARV ARREST
O�a1P4�fe��vre
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Tne Events ResWWg In Dea;n) Last C
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❑ Yes � No
. 30. Weee Au�opsy Fvqvg Araiade TO COmpIMO i�e Uuse OI DpaN'! � �^� � No
� 31. OE ToOacao Use Canmdtte Ta Deatni J2. II Fmele: 33. Mama Of Deam_
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❑ Yes ❑ NO
J8. �ora+mOflnryry-Sdre 36a. GryOrTwm 38D. SveetBMmoer 3BC qptNO. 3BG ZryCOOe
u.xsraceMOwiN��Yaeveeca e❑o ��fi�sw�wn�nwr.�7 ❑�.s�. I
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at.59^awra. o(PesmCrnJ�+ieCauseo'D�ui sY. Ccuha (Cneaq+None7
NICOLE E MEYER , BY ELECTRONIC SIGNATURE ❑ cemmro anm� � c�g ❑�w�orsw
a]. Name. AOGress nnE lip CoOe OI Person Catilytrp 6use OI DeaN: aa. license MvnOer a5. Date CaufieC
NICOLE E MEYER , 301 N. COLLEGE AVENUE, BLOOMINGTON, IN 47404 NONE 07/13I2011
e6. ROE:uaal Funaal5a�im Rv.iOV a]. •ptzs:
<8. Si{puN�edLaolHeal:l�O�:mr d9. ForRplsVarOM/ -DaRFYed (MmWDaylYeati
THOMAS W. SHARP, VIA ELECTRONIC SIGNATURE JAN 14 2011
AMENDMENT TO CERTiFIGATE OF DEAiH (ENTRY OR ORIGINAL)
State Form 533�Fi q7TENTpN ESTATE: ilie Social5ewnry s is Oarg reeuesteE �y �tis sute aB�Y ��g to pursue responvW3ry. Oistlosure is rvWntary artl ihere w1 De no pef Wry fa refusal.