Death Certificate - Midkiff, Harry Ernest_5/16/2012INDIANA STATE DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
EDR No ������24222� State
,1 • 11 • u.
Hospiul
� Hospce Fa�&ty ❑ De¢deM'a Home ❑ Nwzvg HmilAOnpbrm Cup FaoEty
� Yes � No ❑ Unkmxn ❑ Iroaaeea 0 Er.wO�'�mnw Wpa.+m+ 0 DeaamNmxl � Ovw(SpeaM
INDIANA
70041 WEST 550 SOUTH
t9. peaEeneaEEUnbn
HIGH SCHOOL GRADUATE OR GED
MIDKIFF
� e�w � cre�,x� O oa,.:w, O Erca„e�u
❑ RemwaiFranSU:e
❑ ves � No
BSON
VERNA MIDKIFF
786417
� Mnmetl O ManeC. &n Sepax•s0 ❑ Oivorce0
❑ NbMe� ❑ NeverMZrtieE ❑ Unlmoxn
FUNERAL HOME OF GIBSON COUNTY, INC., 319 SOUTH MAIN STREET,
❑ Yes � No
ANDALL K DIKE BY ELECTRONIC SIGNATURE IFD01070�77
Ca�se Of DeaN (See ImtrucHma AnE Esamples) Aypratimate
2B. Part I. En:m Ttie G�am 0! Evenb - Diseases, Iryu�ies, Or CompG�ations - Thai Oveay Caused T1ie DeaN. Do Not EMer Tertninal Events Imerval: Orvset
Such 0.s Cartlac Mast, Raspiatay Mest, Or VeNrialar FiDnlla�ion lMNan Snvwvy The Etiobgy. Oa No� AEbavia;e. EMer ONy One Cause On To Dea:n
A Line. AdE ACdi�inal L'vres If Necessary. .
Immeaa•s Cause (Fe�al 0iseaze Or CoMition Resilting In DeaN) A ORAL CAVITY CANCER SOUPMOOS CELL YJITH REOCURRENCE NECK 2 YEARS
n�w�.nw�e«.
Sequerrtuly L1st ConC:tivu, 11 My, Leaavg To Tlie Causa Listee On B�
L'me 0. Ente� T1ie UnOerty'up Cause (Disease Or 4jvy That InRie;eG ��o- �� ��� �
TM Events Resuttvg In Det.ti) Last �
bl�'Y�CwvY�+W
o. — --
� vu'O araoeM' O Ho.e1o��J" I �'�+sn.v.•w.,PU.«, ❑ A.w�urA.ao..a ❑ rui+.w+e�.r,.�.,�m.�nwnao.c� I� Nawral O NaricEe ❑ nceaem ❑ Pmex�qirne+Watm
❑UnFnam pww.w+.eui*w.+uo.r.rairYe.n.c.a� ❑u.�, r..w+vc.,in.n�rv.. ❑5iioaeQCawNaBeDe:eeminea
❑ Ves ❑ No
3aa. nocwa
,� pm.rs�n
❑ nese,��
a5. DaxCe�SeE
02/02/2012
rzal:
2
�� FTTENiION ESTATE: The Sodal Seaaicy p is bavg requeststl �y W s state agerry in Wer m pursue responsiOTay_ DisHOSUre i= wLntary arq Nxe wil De ro penalry tw rnLSal.
IVFA-?0
(7/�) -� � i , � : � i: ., y�`, � . � � . :11 � � � : 1� 1 ':�11L .J