Death Certificate - McReynolds, Helen_3/28/2011534471
CERTIFICATE OF DEATH
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❑ Yes � NO ❑ UnYnwm � InpT.ian� � Em �y ❑�e FarSty ❑ Deceaenfs Home ❑ Nurseg Home�tpr�¢hnnCare Fav3ry
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INDIANA
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679 SOUTH FIRST STREET
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HIGH SCHOOL GR4DUATE OR GED
KNOWLES BARRETT
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❑ ves � r+o IHOLDERS FUNER4L HOME OF GIBSON COUNTY, INC., 319 SOUTH MAIN STREET, I
OWENSVILLE. IN 47665 FH89000021
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'ANDALL K DIKE , BY ELECTRONIC SIGNATURE FD01010177
Cause Of Deat� (See Inswctions AnE Ezamples) p�p��te
29. Pert L Entu The CJ�a�n 01 Events � Dittases, Iniunes, Ot CompliwUwa - TTa� Dveclly Cau5e0 The DeaN. Do Nol Enttt Temw�al Events In:eval: Onset
$uc� As CarEie[ hiet� ResO��aY �esl Or VeeY✓wla� FlDn�aJOn VANOUt $l�oning TTe Etldogy. Do NW Appravia:e. Enter ONy Ona Cause On To Dea:ti
A IJne. A00 Atltli;inal Lines H Necessary.
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SepuenUalry List Contli:iarss, If My, LeaEing To The Cause listetl On 8. CHRONIC CANGESTrvE HEART FAILFUR�E SEVEftAL VEARS
Lina A. En:c The UMarfy'v�g Cause (Disease Or 4yury That Iru�atetl ��
The Evxnb RewlNg In Dra'.h)1a51 C. CARDIOMVOPATHY $EVERA� YEARS
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D. DIABETESMELLINS � $E_VERALYEARS
2ENALINSUFFIGENCY .••�•��� w �•�••� ��•,,,••w�•� �•��•p,•,�•••••��•�. � Yes � No
31. GE ToOacm Use CanT0.^e To OexJi? 32. i: Fer. W e: 33. Mamu 0� DeaT:
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3a. DYS Of InN�Y (�nWDaylYear) 35. irne Ol ln'ryry 36. Fxe 014yury (E G.. DecMenCS Hme. Cms:nxiion Sf.e. Rmawait wmOeE Prta) 3]. 4y�vy /u WM?
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:- State Fam 53395 ATTEMION ESTATE: TTe Sorial Sewnry
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