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Death Certificate - Pfeiffer, Pauline_4/25/2011INDIANA STATE DEPARTMENT OF HEALTH CERTIFICATE OF DEATH No 000127 EDR No 000000187136 State No PAULINE A PFEIFF 604075 io. u o�u, om,�a m.: Ho:auc im. rc oPxn o��rea s��.r.� om« ma� n n�.� ' ❑ HosPCe FaaEry ❑ Deceamfs Hame ❑ N�rsip Home�Lagaerm Care Fxi.y ❑ Yes � No ❑ Un+nowl � Inpa�m� 0 Er.ue�emy DeO�ent Wyaemt � OeaO m nrtival � pNer l5peolyl 47630 . ' � 705 E STRAIN STREET �5. oececenrs Eaotim HIGH SCHOOL GRADUATE OR GED FRANK � euw O eeemaw, � m,a�on O emoncmem ❑ Rertwvai From Su:e ❑ Ves � No FORT BRANCH VERONICA WOLF ❑MameEQMameO.BtrtSeW�a'•e0 ❑Diwrce0 � WqawN ❑ NewAameC ❑ UnWwwn 47648 SIMON � Yes ❑ No a� ..� a� � ��e ��� u� .�a ..�� . mp�esl 0.�Cmuma;a 28. Part 1. Enter The Cl�ain OI Evenis - Diseases, injunes, Or Compliratims - TTat Diredty CauseC The DeaN. Do Not Enta Tmninal Events Inteml: Onset Suc� As CarCiac Artest, ReSDUa�ay �✓rest, Or Ven:nWar FEnllation WiNwt S�owing The E�dogy. Do No� AEOraWate. Enta ONy One Cause On To Oeal� A Line. A40 ACONnaI Lines II Necessary. ImmeCiat= Cause (Final Disease Or ConE:bvf ResN4nq In DeaN) F. SUODEN DEATH 1AINUTES a. e�o �.. cwv.... Sequenuaily list Con�iGOns, H My. Leaeing To TTe Cause listetl On B� /DENOCARCINOMA OF THE COLON STAGE N ta WEEKS LineA EnterlTeUMeetyingtause(DiseaseOrtryuryThattrtlliatetl °nb1 ��°"�"b � T�e Events ReSW;vig In DeaN) Las� � a,. e�o �..:e..r... D. ❑ Yes ❑ PmGpy � No O Unt�w.m ❑�..,.,,..�a.�...... ❑A.,�...�r.»ao..� ❑�a.,..,.a,�A.,,.....,.:o.,.ao.... �NaynlOVla�tldae ❑ncr,aem ❑arna,�ei�.eswaea, C�IMMP�KMRTtiVtti�:e�tirl�b�0.u� ❑u.��n�w+we.�n.n.+� ❑SWtlOe�CwIONatBeOe•srmineo I❑ Yes O No �.. npt W. 360. Lo CoEe qvry�+u�. �M. �ISw�I CIXOnlr , � HU: OP..Cl� w �5. DY.eCeM1SM 03171/2011 s33B5 qnEMqN ESTATE: T�e Soval Secunry e is De'ug reC�esteC �y Nis state agenry in aNer to W rsue respmsiCAty. Distlosure is wl�ntary aM Nae wi0 Ee Iw penaRy for rchisal. NRA-20 (7/0.5) ��� .. . . � �. _. � . � � � . e i � [ . � �. � ..��..� .