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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)
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