Death Certificate - Redman, Robert A_2/2/2012Local
CERTIFICATE OF DEATH - RESUBMIT
EDR No 000000233589
���bll
12/09/2011
❑ HoSqceFadtiry ❑ �erndeN'sMame � N�rs'ugHOneRaq�teimCareFadt.y
� Yes O No ❑ UnMOw� ❑ �noa�eru O Emer�ersy oepertment aTa9mt O �eaa m nrrna� p osia lsox W)
607 EAST BROAD4VAY STREET
19. 9KNMY5 Etluca]On
HIGH SCHOOL GRADUATE OR GED
ARTHUR
� e�nai O crema:im p Donaaan � en:«noment
❑ Rer.nvalFransns
(ANTIOCH CEMETERY ICYNTHIANA. IN
21. t�zmeAMGor..qe•sAOtlres50(i�naalFao5.y
HOLDERS FUNERAL HOME OF GIBSON COUNTY. INC., 319 SOUTH MAIN STREET,
❑ Yes `� No
$ MaMea � Mame4 Bv�Seoara.ea ❑ Uro�ceO
❑ lMOOxeC ❑ Ne�er Afane� ❑ Uniawv.:
� Yes � Nc
ANDALL K DIKE BY ELECTRONIC SIGNATURE IFD01010177
Cause IN oeath (See Instru<HOns Antl Examples) Fpprouma;e
28. Pzn L Enter TTe CJialn Of Evenis � Diseases. Injunes. Or Complicztl«u - Tlia� Directy Caused The Oea•J+. Do Not En�ar Terzninal Events �;m21: Onse�
SuUi As Cxrdix Me54 Respi:a;ory Mest. Or VeNnMar Fbnlla�m Wiswt Shwir.g The Etidogy. Do No� AE�eviate. Enter ONy One fause On To Deau�
A lit�e. A0� A�GCnal lines It Necessary.
ImJnediate Czuse (Final Ofs?ase Or CmCiticn ResWtl� In Dea:n) A END STAGE LNER �ISEASE e UnKnO'h'u
.. _ re.w....
SeauenUalry us� Conaiums, tlMy. Leatlin9 To Tne Ceuse Ustea On B. END STAGE RENAL �ISEnSE a' .�N�� UNKNOwrv
LineA Enter TTe UnEerfying Cause (USease Or Iniwy That Initla:ea
Tne'even's Res�'Siiq Ir, �ezV.) Last �.
e�o a. �..ww oT
D.
❑ Yes ❑'roDatly p No � Uninw:n
. �muu:os
i9:13.DEC-11
J 5: I'v 12C011 13.W UO A M
i9: 13AEC-I I
35: 1 Llb'011 I'_:00:00 dU
;iC1ONEYD15EASE.FKEMI0.GRF2H051$OFLIVER ..ve.e...nowvr.�uayn.aiuu�ew�o�..�w=.�����..a�.,�.,�..�e... �Yes ❑No
li. tt Femaie: 33. Mamd IN Dea:n:
❑�a�+m.+.cwam+.., Q c..-.:w.�*.�.ao..n ❑ we..s.+a.w.s..,�..w.c�...he..n 0 Na:urol � 1ionGdae ❑ Acddent G PenNgimvs;iqaaon
flr.rnro�.+e.�n.r�+.�anra+...�e.e�.u.n ❑u+».,se..r.uw.+.ir....r� ❑SuicWeOCONaHaBeoes�m'viea
s.
a�sas
❑ res ❑ no
3EE. LDCWe
n Qw.ls+'hl
❑ nl2NUP.C¢�
a5. 9's Cs.SeE
i vi zizoi i
r�arx
t
I
�� ATiEMION ESTAiE: T1ie Sotia� Secunry n is beiry �eP-'es:eC Gy Ws sla:e agercy in wEer to:ursue respor.siLaty. Disclosure is vdunary arM tnere �.i0 be �w veral.y or rc a.
ib- e: z0