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Death Certificate - Nelson, Stephen L_4/7/2010�". 1itl119'AII�BiI�7:liICI111J�17Q.Y1:11i11779Y1Pilitl��la717J�1i� � 520361 INDIANA STATE DEPARTMENT OF HEALTH CERTIFICATE OF DEATH � Local No .................................... State No............................................ L'JttaVtNSLeq�INane(FRtM1lt.liq� - a.lAaEmLUINmeQIFC.aIt) 1.Sfi J. Trt,eOlOeaN 4 DafeqOnLtQAxWOiy/Tmr) STEPHEN LEIF NELSON . Nq ta 1:]e P.h7. JANUARY 29, 1010 � s. saoasro,mrrv�,-ar e,. <a�-r� e_. ��.<.,.o, x.�:,<e:�am m. �.,u.� e.. �x.,..w r. on�c�era e. e�.u:wcel�avnmsu�eaFVa=�.a+�+m 65 ��.r, I o�, ,� I�....., lMw.rayne,q MUNQE,INDIANA OcioOer 3, 19aa I 9.EwL!ISMMFa[v) 10.IIOCrttOC�rtCNA9p5(Vy: . . . � 10].pyaMOCMlMSR%w�MCV:.Hilip11b5{'CL: pYss ❑NOUnt;r.wn❑ O�oa:ectOBw9ercyes;r.rcr.t9v_rxrtOe._cOnimva� ' O Fcs3ce Fza,y O DtteCeas Hare �� Nwv�g Fiurztar�ian Cae Fx3ry O C:a 15;,eo.y) f f. FamtY Nme pllN NMUfWn. GM1e Sren AM M�m�sl� _ _ I MILTON HOME � iz. uy o� iawn, sme. nna zio eoae �a. ea,nry o� ouu� �.. uany sa�u� u r.rc c 9eam SOUTHBEND,INDIANA 46601 ST.JOSEPH I ��t�x�eepMxiieo,=asaarseapoimcea ❑ w5ao«rJ Q Hna uar�e.^ O U:v.xm IS. Survrvvp5povse'iNa,r.e 15a. (lt'f/ie�ii.eMacmLiAName 18.Oet�eEmlYVU�lOmpaWn _ 1). YxtlO(BUSinesiNU:Wry CONSTANCEJ.NELSON TOWNSEND DENTIST �EN715TRY :e. a.sue�a-vne �'a. ewmy :!o. uyor �w.,, INDIANA 5T. JOSEPH GRANGER tY. Srt[�N�JNVnpu 19E. P[LNO. Ife. ZqCMe .. -Ye 1 5. 50700 WOODBURYWAY NA 46530 ord oro in. aeuae�csewu•.wn m. oeceeemana.wvcayn z+. oeucm'sP m Protessional tlegree (e.g.. MD, DDS, DVM, LLB, No, not Spanish/HispaniULatino White 21.'FMe(xNamv(Frst,MU]Ie.W1I :J.HOI:.elsNamelFrn.MG'.Iq�asy ua. s <n ....< I JOHN GORDON NELSON NATALIE ELIZABETH NELSON WAL7ER5 . ar.0 x.ame +. .n. ,e.o-_ e . arq im� e .r.m.�,.r. +e.�o COr+STnNCE NELSOr+ WIFE . 50700 WOODBURY WAY GRANGER, INDIANA 46530 25. PlaceOtDisrosilion 2_a.ueveo�OCrowrn 35e.Ramoto.spnsitianMmeo�cs.�Nrn.�,w.a'+K�a) ?se.teueon-eay.iwm.nnasUh O&na�Ger.ueon��maonOEr.iwnMier.t \^1ELSHEIMERCREMATORY SOUTHBEND,INDIANA ❑ �enwJ km Slxe � a�ulsoechF :5. N'u .f.omnel CpvtaeeE? 2). Name PM CanY<le TO]2A Of f.�neral FatiLY 2ia. Fv�:ml Mm�e �xel�5e vw-]er Oves �no WELSHEIMER FUNERAL HOME 521 N. WILLIAM ST. SOUTH BEND, INDIANA 46616 FH-7aao0075 zre. sk�aivreoiuieunaFwerasenreureivee_ zr<. �ce.xnwuerlaucemeq �� ` , f �] /% FD-0100970d - LUy�y� Cavea O( Ueath (Sea Inswctions And Examples) 2:. Pan L Enter TTe C�ain Of Eren�z-0iseas=s, Iryuries, Or Compliuuons—Thal DveGty CauseC TTe p=_a:f� Do Na Enic TemJnal Events Ac���ale Sw� As CarGiac Prrest, Respramry Mest, OrVenVirular FiDNlaum Wr.MUt $boni�g Tha E�dogy. Do 4ct AeEredate. ENei ONy Orie Cause On �merval: Onse� A Line. Te� AC6tianai L'u�es ll Necessary. �( / Tc Oeas IrtunxCia:eCauta(F:.aOis�auC:G,:�.....,.:.Rezcliir=-Cea:.• n. C'� i• LObQ ��(0/� �eoeker� Q��on �O 9 O� Seduen'valry Lis� Corpi:ions, II My, LeaCing To The Gause listea On B. � � mK � LineA EnterTheVM�figCause�Disease0rlryuryTt�:lnliatetl •�64��� F•� Tne Erents Resu'ur L� Dez'.1�)! =_st C a. .�u...c...v..R.ur I ameEne.ou+ers �+ca ' oe ame+waoun�i.,meu�ae�ryvycamecne�mvani u...pe ^°�r ` s�+a.. e,o„�Yes �NO ` r:n nT— . rmr r, e u ❑ Ys ,�T'o JLMioWCCODUCY.Alei00eaN? I ]3-tlFina!e; ll.MametClLeaL•. - � ❑ Ys O k.aM� Z{!b Gua , O ua Hqv+NtYin?asYm O Rqvvu imq 0ex� O W Rqat eu Rqu�t W�n R Orhpaun p war�l O�trox O�OS� O PonSq 4�vh�o, n Q�uH°-M9�Fqa�aM+totTVBeIV�D.L� OUi �NqvNNn,.3nre OsvM1OCOYNa&0.ae.n+ J�.Oile��U{f)'4����YH� ]5. ie'e014yYf/ 3E. PIaGOIL'F:(�.G..�[fCEeM'sMCTe.:AZ'SJVNNSYe.Re]4WYKWCOClGNtal li.IqYryAIIYGY? O Yes ❑ Ib b.Iw0:nC11ryury�5l�le 1ba.iJG�enn ],O.SVM6Mrt.�tt 3lc.F0.Ne_ �W • I � �_—. ao. uin�.soonw��nN�y.soeory: SG p[Wi4e Mw Injury O�rtM - o a:«Rp.n+ o o rea� ❑ x. m�n .:.sy�,rxaoia.a.,:cer.+ri+3c.�x ioe�: /�— zar,�aeer.�ua+ro��� �/ `l / �/ ��j//��' � /L_ A `� Cer+fpn9 PhY�an O Ca.r.s O tkzMn asce 13. Nane, Addr¢ss F:d bp Code Of PersOn Cer';ryg Cause ll���V ��. ���+<<^+^ar s. or,e cer_r John Kubley MD. 111 3ur,n,bronk Ct. South Bend, Indiana 46637 p�p� gd jl Ux�or ,(a/O b. MH3ina1 Funval5tt+u PN�Cer �]. 'ILS: �. SpnawroM Y• 6�OG � i. farRpiil Y-OileFiM�lAn�'J.WaYIYm�: i' .a � _ . . .. .I