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Death Certificate - Pollock, Arthur Ray_6/14/2007_ AT7EHDON ESTATE: Tlre SOdal Se[u r.y, f i5 . . — "w�s:'+a;`�"_u�a��cry �sv a`�ea"laey`�stlosu e is INDIANA STATE DEPARTMENT OF HEALTH '.rohmtzry ark c�ere ,rAa oa no pena�ry hr retusai. r : �w.....,�..Ps-a.0.0 % �lor: LNo.. ... .. ............. nie a=_ecr.�s w nns senr_s ;ae � � � ottusE_—NUC v.n uao. i.w ' > -1m' D �� m ;>_ � � .T1 4 ��, n °�� � �Zr. , y-z �� � H T — h�ti m ��� � I � v : N ^Z' O �OC O � � T ti p0� Tmn mnr � y vAiyT v+ G C) nr..? c: J °' C. �' C > j ��O r :�' � l�' ci os < ti �� r 1 r., c sZ � >� � R' O _ o� 0 2z -i O � y U• n z0 � mz 0 on � Q n p r G O �� n � � N i � nm Z o� � mT N � O m > � O I' y � C =� m 2 R' m� �v I � • Z ^ OU t�� ? Z ,\ y ti � K 1' m = � Z r., �r D _ �Z � � � ,� � � \� � NRA-20 ' (7i05) ..-•sacuisecuwrc.uuern s. ��t-i.vowx <YSII 7g v w.+5o[:��a:: ee •tant�s�scmrtcv: ♦US'lE:ESrv! IISd1Of7[QFC��' ro �/a w ..c.�-......:�...�.,.�.....c..,...,..r....a�i 'L'�e 4�_eCS a`. PCirxz*_cr: �a u.n:csr>ros � ss.*.wcsrouse Ir�iCC'12� +MZ!31li � R1C112 IL �SDE�CE—Si4E IA CIXrviv Irr7iara Gits�t �]� IVCOJE �Y �$nEbiV�MR :�iCfAO' ❑ r:e kl v.�n<r ecv�r �:i ON � [�FN+ ' �1 F<(!f.95 F�Mf 1l�C 4m� U�l n.�'iT�.. �b].].C[jC r�. arCwar,rsnavErt.�..�r,a � Yr�iu ?�]lcrlc ��. �:b�����9r;c e:�-� '��' 6aal ❑.'..wr�.. [ vcro.Jr.mSrn� � Da�.:-o-. ❑ GPV tce�e�N It1 EVE�t�EPSb��E Fa�tt [4. C7�.•la <_ 'Vr/s��� :, o� :, E,��.e � iur�n�:E Csv3 �... . ��.�wm ��_.an<, <avm�� �.-.r �...n:. . �� • Pa m-KSe (eu��•• enRe • � ..... �n CERTIFICATE OF DEATH PERIC 16.?��: ;0 �s�r« a �-�..,. ��7,.:1�6 State No . ............................ nu¢ pe [ �9:3� P C'B4RM:W Mf In arv 1, 192a Ix oa:Ea�'w.rr.�w..>. �r h$y 17� 2�6) &n%emt<CE IGry m �ra� o fr� Pc'i.rrvtrn, Irrlian; � �„� �. ❑ �.. «.�.,� o cmr.*r+.+cai,ca:c.:�yccer. P�llk.t=Ytfl �:, oecc?x(Nu:susu�oec��ar�a+<o..�.�cu.o-. Jw'.Y..LEZ'F�'1Ci�:f� u� 4.+x.w v�al G�_'}�r,Qi :••.� �:e vDerwswcsy�n:a.5:e. 0715-�riLt1R! % qiv.tOwu pptOGa:pn tJa S:Ik£: e�:p�y�{a PL7I1JEtClI �1 Fq]I. t�7 1i�R. �)'�'�SCECfCErvipiMSp�nXpq�[v�+ �6 NC£—:wc�:lnb�n �l CECE.^.FN:S`_CUC>:hYl I u.Y. rw e r.. a r.. .c.�e. c� e.�r rr� .m I. 's"`n o+. ^c.c n.e. �>..�.a ea+P.avmFe�H:I (50e���)• � E' YGall>iil Cti�� . 05 S'tlLi.c I 12 I 'J I1 a 1.1� �FfA$ M14VE (f�it Mcy1 M�Crn $y��.�l :wM<nwe.:�cnc:s�s>.�.mro..-el.�y-�a..,�..-�.erodr„�:s...a_a. , m F..�c .: 3�1 FUa-Ch A�.e., Prin�trn, L-rlian� 57� � tai�e ncDai�anc>_aaoeNSWV.a.�c..-�a,. .so.�..mra nc;<U:a'�_�.era�.s. �..a.�.l M3V J1� 2J�% I . !�'�. �114E .�iL�-�`J 1'li �l�iitl5 I' Pe Eve�ay�'�.rtyPSwbCyE�U5En0 � :J v:aSCfa*r.PEM�:fL:OCJaC:.tm '�UJJJJJJ tiT-' �w C v�� IfC3_2,�'k3 uCF.tiSE'�UU9EF I:Sr:a��y.n_�SSCnOUCE::_;.i;rC+FaCiFVqP,;�.-C�•.( � �.y:K..u.. I �lE �iTPSd� KT2 �Ct:�.�l� �D23`�UP 52J 5. ?ain St. Pri:-��rn, irc9�_a �-6'x'� �e:e4.r<... ew _.,n.a... a.nu+ Co.a t.uuw�.a.x.:.-.�.�. me.+u.o.��civ..a r.rn..u_rc.�.e.a . . 1'�!:�j-- - '��LL!'�..z.k`, � nr:n�ma.�.�i�nsco�ti�:ceo.� � �i �I.'i ��i A - �:(�I i.I 4" OIEiJIGVaSt�ti ��EtiLEC�I / , i���.Sn, i(;f'l7 ;t..:iZ,'7/'.�LL�t-`y tt.E iOIGn � S= C W:SEp.�E.vCE C-1 i�rl: C�e� a.}I..cay <YG�en . Cm:i�m� [a'vA'M1p �o <uC %� m p�.^w,J/ f.NN n C�.1 :9. CE9iir¢F aGr•aq mel :90 JGM_:v=F <�C ws5 OECEOE'rt n wn5 eb nU:G:Sv �'�'vU:�A: CR S'J CarS CElSOMQL' ep5:vanrou�, trna�rcJ !`rM b .i m va'Gn� IY V.iFC PVT'u-SY f \G:4: >':SlPBIE[9CR:� CCVttEi On pf Ul_! o, x. n.. <... > �.�, iV�-'. IJCEP.�hI'„:M�yCAPN e�y%:afr„ywke�ecm.�u«�ree��a��u+ee���wWC�rvaeet�ec��s�l�lufurrC G��::r rs.<ca a m. �,.. w......�:� ���--lmr... �..�. u.rw . M N C�e G�e �.� pYfe �Y M:o P� <wv�lal �� P6e] ❑CO°O�YP. Tm.b�e J'cn.y� e �a.0 . naluv..��.e.��Tre] `� ` � � . CTi - � I_ � �� � � :9 uF C LLtKE::5fA0` `. r e E Sr � „ �`;/� , _=�s ,. J , I , � -. �c e+.u�cw1•f �a�/�x ELLKE (;. EYl�}C JC ]' +EaL'rO�S;E?SS�GVei�� ocv.fa �^ CF�tr e...,.,. ❑ w,� ❑ . ..,... ,....:�.,. ❑ s�.. ❑ �,r,.,_ G�-.�.�. o.�..r...� / ^"`y" • vcc.irart..z l7.�. ,�� N.LI�$:fl $t. � ,�� G. . I ly CuECFnf_m I l�] :��CF Iwi� C�. nrl y{ppr ?fYil.d(L 4/6/� ��� % J�< m:Cm c: WCFir I]x CEY4pj..ry.vmLCr IYnc.,1 � i ]] C�iE FiLfO W:.n L+. rea�) , ��.��•� :_�._ � ..,,.�,..,,.«,<k. j -���..w..<�...,...,.......,,._.�,_,..�.r,_,>�a, .� K,o .. �_ , � � � . . s.. WtEwOrrvaCEC'�EeJ:w+n6r. �. Il.• uCfCa;sa✓lfeCGCEn:+t•nv+vi r-�.� memw.rc /ln+ae� u�x�qre SONO6-0W State Form 10170 (R5:1-S9) �