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Death Certificate - Priestly, Burniss_3/12/2007u :.xi ;.+�'<..;�;.::a�:+r.n•.r.0 •,.:u::,v.:4 . , , �:...,,,,,...•::�.�s�:. at ay.uw�t::is.�... :15 a:t.t �a e •i1l,il:+AS3 ' RTTENTION ESTA7E: The Saial SeCUtity D IS wing rr�rleE Dy ihis state a ercy in ortler m p�r5ue its�s�aWtory responv6i6ry. Diulowro �s I�NA STATE DEPARTMENT OF �TH •:�P.ntivy atW iherB will0e tq pBnahy 1or r6:usa1. UtS (�4U Lxal_No'.....>:.'-��=��'.-?L........... CERTIFICATE OF DEATH St2te No . ............................ THE REGOROS U: THIS SERES ME CONFIOeNTIAI PEF IC t6� 1�19J � I i. cECUSCO-nnue rt.n uaar uw� I O (n O -' �7� �['y�l > � m x _ 1 D.v �; �.. •socuis�uwrvnuuarn s sct-�.vame.. � 7D.1 (n � �v„�y�„ m -� cFf m�mZ� °:us�riw; �us.`w�niovmw ��r �` Ye5 195� `�= n -S1 mF<Ctrtrnurtvre�rmm�w+�n�e1wn>mno.n :+•i¶ G'1 Q Cil .}i.'1.71 �'dl F�J'llGu �'�:: _ � _ ��`< io u�� s�>rus ii.i��'�""i. v.:'m.e .�.i `a�j � ° ° I rarria3 t�srd3 Lyles i� ti iL. RSIOFNCE-SiniE Y. C(TR:i'r � ° �� I L�r_liara I rilxr.., � :� �mn (]nm iHZUCCOe�ix. s�oeu:vi..e*s i.u�z��or m � Ne C Yec wneiCCV�:R � � y � U= I�p ON A FRIIMt n�� 476A � c�. Na ... � Z m m ie ra�wrnsu..a�r.:.o�. i.m � C O O i�7ll55 f�C1ESu� .�.,~'i . > m � � ±�. eaoroian�rsnu.a�rrvva.n � - � r L�rd: Priestly �_ Sy� �.rt:nCJOf05o0511Mn ❑fnxame� � N C: Bur ❑ Cer.+ean ❑ P+mo.� han Lv� �- < � ❑ au.aa, ❑ ce�. �SO.a,� Cj r 4l . }>� FABAluFASnnuF N O 63iietC W. Daj12 Nz >/..� sm„9rur,�,o�ru�r�� oxEC,oy � m DT \; ~ • 1 f—�' � > r � / � Q Q_ `i � U-!' � V ��r.�.i�� "°"' ",`." I cxraxr �, i9u �asa�:u U o-a..... 11� �`C oEnr„ aun a. ..� .y iz, a� rs..�. mu. d rv.. n �,w�e,,. ❑ �..,,�.,, SC CIiY.TOWNOFLOGRIlOM0fCf62ti W COUN1VOi0fAIM fi1fC2:TII1 (�il'�871 �Y Clil'.iOWN.ONLOCPiION Prinn?t'm IS W�Sp ECECENI CF Y6PtNL CNqf:� Etno G vn m y.a we.�r �� ue.<.i a.no nc.� .F� W16.�wo��o� R11ppBV".n6C:/��OV6iPv � nx �rs� rqw) t c�� T�� L� .0 �� :itl � ib 51REinW�N1!u9EA R.R.�3 FS�x 239 �6 MCF-6ew�tmM�m 6�[l WI' �.tK ($o�c�/1 ffiadc 19 IIOi�@115 N1�E Ifia 4fq'h �4pq S1rone1 Nina �vie I l. CECFCFNI S IX1C1ilON 1$p{Cly OII hl.'NR O+C� N W L' � I 2 7n .ate.t <oerESS �m...m �:in,e.. e.a..i �b,.e H.,k. ur e. ��..� sm, ze em.� x,c rie.m�..+e R.R.63 3�x 239 Prirx�rrn, Irdiarr� 476'7C) wi£e ile OAiE 4N0 RPLE OF pSPOJi1pN VLnr d ureien. crnnlpl p v�rpcel �Y1.HL� 17l 2SY. 53rd Hi_ll �tetery ]IC. LOC�T�N-C�y m ia..n $taa �-•_z� '� ]leL�E1M�yt�nl/�yEyPy5yli�CG5FNO ]) wa50EaiMPyEP�ONIE�tOCOPO+RP' ' L ✓LJJ�M/✓J ❑ Na U Y�� }�0 LIGErvSEHINEER 'S M1YIEap011Ei$ LNDLICENSiNUlIpEflO�flI1QRLtN0�4 12I'1.atP.CH1I17fe E1110400010 FB�r.�0�03 � 5. Nain St. � Pri�tm� IN 47670 O .� Z :� C<P� � Erta tiva,u�al+�.�,�i� x u-sscsm� v�w avean� ac. �a ro� e�e. rovaulc ie.m� awn.� eva: o- re�.rr�u�r � TO ....wu....��..��.�... e-..... ..enr. f. �I-- _ �� y ' • �. m y O, uuaaa;cc<use<•��» l%�.` 1�!1 �C ,–„ mz G..:.v<ow�a � ouEroa� <cor�CUEV. Op� «au�c ��.N i I T ?1 m e ` � �n G ASVUlnf..MirtnWr� UUEIUIC`H1111'JtJLVIRe�t;[Vrl n O b M inr%��1� <N�l. ' G r � � 4 �~r� < WE :O �Cfl s5 c GOnSE�I.E.v�E OFl ' a Z a n D 1 � v� � ' f(IRi oaP�1��Q�+�e.yM<w<myn.ero. <uMmata'rMm�ve.wN��WnPnl ` �� C'��/'2tcti�{ ��f �i`�1� ��1�2`!'I�jCt.� < m T �+�, . �oe �' � m /� •.Ls ' ,u1 �,��za.a� - CL4'1,��ti. �� a u� e�vumw 'rtr.JBU.w+ aw� w aa }� wc5 oEC[oU+i >b wsSV+�uiOPSr ZW WEPEPUioVSVfWOwGS aqECNaNi p5 Sp 0��5 vF1i0�¢D+ �V/�M1wBtE?AON f0 POSiV�PiU4r (Ymnml COIAREiqnOfC/�1L4 1Y0/1..� rol �y CF�LTMIYqpTJ tVJ LI.! jTO ]W CfALIFER CFfli6:JiGPMV[CU.I: iOtlYEMdnI:�o�yy�Ee�.9rc[w�eeO�hln.eat�ueob[�vaCHrvP�uu��(�IYW:K _'� ��le'[IUY Am m � ❑ NE4L � H O�f10ER On Vw O�aa d r�v+u�a� vE/d meN:mm � nY m^a OuN r<cvrm a� Ne �me Ule W ebce �m u.n pY.e rv��l�l �� Y.yp m ��m� O CO�EP CF �e ua�� d e•w�oon vn/a e�.eH�um n nv m'+u� ee++. acv�w Y v+� dn. ane �rc C4et. s�a M�n c�e una(J va nawr �� uua \ -y� . zs rrtiEGfCE=Srt�• �, �� s sv�p� 1=O � ` ,l// �'_- .+s�.r.anCe�uCEnYno zro.r[4Caou+amn.r.r.ti OlO1 Th30 �—:� 1� �'1 � ' � A�t>�.kR.`C1WO�i550�PE?50�'xnOCO�EiFOC�U5E0FD[<t+�LEN}blt'yx/RrA �mn 1 y� Willian [2. [^�ll� M.D. S10.N.� N.1in St. � Prirta.'�tm, Ije'liara 476/6� I�� Z � � K �� M�tifOGF'.CEPSSKN4IUrQ � �mx "'�% u�rvrsvn�nf��r >YOAiEOFwJUF� f. Z. � . �+we. dr ..n �, O = ❑ N.v.i ❑ c.%< ��t.I Y.naKUm ❑a L�/ / � G. ,� � �' ]�0 Iu�EO° I ]�c PWF�>I WOP6' vINFY [Y�� a MI �.-\ � cccw A.MnCEO��vNSr-p�nemeJ✓nmenl�cwr.eXa� � y ❑ C.a<� ❑ CW u!� s.l p e rir`/yl pdiE F4ED (Mam dp lnrl ]�a OESCNCEnprv�+.�WVOCCU�EO Nt ipCa: qe� (SVen u+e rowee. e� 0.aW Po+� 'w�e�r, G� m�a...� Sne) Delermrp I ' '� ❑ F��« . '�;�`.��,:� �.00accaunourKCOOe<ouw-..+wrr..n �.nIM�iOF\Y19GlE<CCIOfNislYefYM1 vr..w.�rw...e.,,�xa�w�•K 1 '� �� SDHC6-004 State Porm tOtiO {f74/3-93) GeaihceUPD t i . .....:,......,.r._...,..,...Y_.-�.-,�... . ..Q�..,...._.�.- �'y. �.�. '_ ,,,,..