Death Certificate - Reinhart, Richard D_9/7/2011CERTIFICATE OF DEATH
eoR No 000000214543
D REINHART
634071
cesa io.1( Deaa� acvnea �n n nosonaC toa. it Daa� ocarree Somewnere Omer Tnan n nnsp�.a
❑ Hospce Faatiry ❑ DeceaenYS Hane ❑ Nurs'ug Hamalag-tam Care FaaLty
� Yes � No ❑ Unknpm � InDaient 0 Emagency DepaNnentOuyapeM � DeaE on Artival � OJia (Specy)
GIBSON
458 WEST GLENDALE STREET
19. DeceCmYS ECUCa�on
HIGH SCHOOL GRADUATE OR GED
NOT HISPANIC
DECKER
❑ Bunal � Cremx.ion � Donxvon Q En:anOment
❑ Removal Rnn State
❑ Othc IScecilvk
❑ MameG� MameE.9ut5eparateG ❑ Dlvorred
� Wtlw.etl ❑ Ne�er MameE ❑ UnMavm
� Yes 0 No
❑ ves � r+o DOYLE FUNER4L HOME, 520 S MAIN ST, PRINCETON, IN 47670 FH10400010
1p.5giu:ixeOflnqanaFUnaalSehicelicrosee: 2ic. LkmuNUmper(OtlicenSeeF
ARRETT W DOYLE BY ELECTRONIC SIGNATURE FD29500009
Lause Ot DeaM (See Instruc[ions AM Ezamples) qpprwimate
2b. Patl L En;er The Gain IX Evenis - Diseases, Injunes, Or Compliraports - That DirecUy Cavsetl TTe Dea�h. Do Not Enter Temilnal Events In;Pfval: Onset
Sucn As farEiac Mest, ResO��a:ory Mest, Or Ven'.eicWar FiDtilatim Withwt St�owing The Etidogy. Do Not AbDreviate. Enter ONy One Cause On To Dea:h
A Line. Adtl Adtlitinal Lines H Necessary.
ImmeCate Cause (Final Disease Or CorWiUOn Resultlng In Deat�) A� ACUTE MYOCARDIAL INFARCTION 3 DAYS
w.u�o.,..�eM
SepuentiaM �st Contli.ians, HMy, Leatling To The Caise Listed On B� �TERqSCLEROTIG HEAf2T DISEASE 20 YEARS
LineA. EntetTheUnderlyingCause(DiseaseOrinjuryThatlnitiated ��je�����
T�e Events Resui4�g In OeaJQ Last G. HYPERTENSION 25 YEARS
o�m�an.nw�e
D. _
Yes � No
31. UO iotacao Use CmOiO�x io �ea'�? 32. If Femaie: �+..^+arnP+� ��:
❑ YPS ❑ P�oOady � No � Unknown �.�'A���vmv.. ❑ � .�:.'.wa.n �.w>i.P.�iann.wnwu.�.zo.nao.e:. � NaN21 �lb:rvciEe ❑ AcaCent ❑ PenEVglnvet9gY.ion
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VIA
(7/OS)
ceivr�er
❑ Yes ❑ No
. ApL No. 38G. Lp Coae
ur'��� ❑
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Cam« ❑ neaY� 05cer
Kr 65. Dax CMBM
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Secunry tt is �eirg repuestetl oy tltis sfate agency in orEer to pursue responsiGdiry. Disdosure is voluntary aM Ne2 will be no