Death Certificate - Rexing, Albert_3/22/2011'" �"{j�"-? —"�-� INDIANA STATE BOARD OF HEALTH
..j W 1%S�i�+— .
=alNo............o�..���... CERTIFICATE OF DEATH StateNo . ................,...........
G H
N
S
F+ ID
rt H '
n
'� U.
O `G
E
n
� �
v n
n ..
f� F+
U M�
n �e i
�
U 5- afiNED FOqLE51
Po FPC4ITVN>MEI/npnRt
Deaconess
10. uAPoTPt STaTUS—MVr�eO
Nwa AWrk1 WtlowW.
lPSi
LL�1\1 1
5� <GF—L�p Brt'�eay • Se. UNDE111 YE>P Sc. IWDEfl � DI
[Ye✓sI �� ��a D�YS Mwf Mi'u��
3.SE% I]OA�EOfDE�TMnn.urni
IMSli �>. 061i1�LaGE I UY �a Sun r Fneq� Canvyl
HOSNTPL ��� p Eii/Ouiwueti ❑ DOA I OTNER ❑�� �M ❑�
py� pM �•y nurv,y�) 9C. GTV. TO�MN.Ofl LOCATION OF DEAiH
ospital Evansville
LLSUFVMNGSPOUSE Ib.DECFDENi5U5UelOCLUCPTWn
u.+>v+.,�.e.n�.i �c�..waw�em.a.ncmenai.e,�.yu..
e Teresa Goebel °o�""�"""' Butcher
CWNiY OF OEdTM
13e. NWD OF BUSPlE55/P.'WSTRv
N �� �Ia.FESmfNCE—SiAiE 1]O.CWNiY 1]c.GTV,TOWN.OHIOCPTION �]OSTflEEidNDM1u9EP
w � Indiana _Gibson Haubstadt R.R. #1
� w ' T fwSPnMCOPoGw1 iinnGE Wun ieDECEDENT5E0ULniqN
rt
rt
S R
� �
r�
o m
D
� o
w v
7 K
�
7 F+
R !A
n m
� �
n
O fD
n x .7
a w x
m n ri
R fn
O
M �"I H
fD N
rt �
S �c 9
n �
a c�
< n ,ro
> rt H
Z 1'� H
� � �
< 7 H
t' ''n �
[-1 (7
rt O
C S Rf
a m .t
z
o n o
IT] N �*1
'F � 4
r.� n a
C 1+� Z
7y n+
x � ',�
: G H
Ci R Q]
O f� H
C y
z o >
r3 i-n C-'
„C
' d C7
C7?1'u O
n w c�
9 �' �
:� m
H �n 2
3 o y
z n
H n
S
O N
'=f
. ,o
x m
[•7 H
9 m
�k WSIOEGTY �9. fAHM . �]q Z�GCODE �� wnS�ECEDEN O —�+acv�
lDAisltre�aro> <SeeclyNOarer.sreasxcryGWn BYCtiw�+ee�c. IS v w.cenWned
Mean ArtrtaW.pt rtJ i% No � Yu l$p�[/y) pm�Mny/5 1(0.1D CaMO� U.� a 5� 1
ivo No 47639 ��rr White ��L""
�). Fdi1¢A$ N<ME (F tl �41'Y Ub IB MOTlIfA'S NAIK IFia W9e. MMen Sunieel
Henr Rexin Gertrude Wannemuehler
�s. P,Teresa Rexng �sR.,RwoA#15' «...�.�,�.,,e.,aA,��:. IN.�.,P�.�6 :no�, � �lh�
Haubstadt 7 39
tN METhOD OF OtSPOSiqN MO DAiE PND PInGE OF p5PQ51TION INax d cm+eury. oa+vury. r lM. IOCaTION—GY u Te+n Sw�
(i� e„w ❑ u.m.u� ❑ w,�,e.y i�� sm. �n.. w.�.�
❑� ❑�..«+,� 12 21 88 St. James Cemeter Haubstadt, IN.
}i � 51C!lailAQ OF fUNEPAL OIRECiOR ]i0 UCENSE NUAOEP t1. NnME aDDqES$_ pND LICENSE MII.�R OF FUNFML M0�4
� /�_�� �� /�� �"�°^�^� Wade Funeral Home #FDH3002990
��c��� �� --P��C� FDE101�08d 119 S. Vine St., Haubstadt, IN.
Camd�i� �eva 1L.c 3.L Te N� Mn d nY �'+n�C�. �an xcvreE et W ome. Cne. W dace �utN. t]0. 11CFN5E NUMOEfl }k D<TE SIGNED 3(
.n�n cmJf+q MY�•cLn �� (AbuRWr. Ye✓1
nq �vt4t/a M Wn d UM
b[eMY[wf�WWW S�eWV�/MlGG � . ' .
N. i4AE OG DEPiH t5. 04TE GiIONWNCED OEPD UloYltlDSy. YesQ_ I'` �
��y
i i� U
}). GPlii l Lva N� Guwi H+��. n ta'nWC�tbn� Nq unN N EuN Oo r�d enn N� naM d tlY�KI w[� �� cudc > rt�MHV�
ai�rt Yact ar Ie�n 1Wr�. Lla aiY om/"c�wa� m ucn fr+ (/ /�
IMMEqniEGaU5E1Fµ / / /��' •J�/� /l ,// /� /
w.ne>fa,emn • � ��� K c�
���Wq n eMUU WE i0 [pR as n COrtSEpUENCE On
�
5.cv..mry w ce�mim.. e.
1 vry.4W.q w�.:melne WE TO fOH AS d CM+SEOUEHCE OFl
uuu. Ena UNOEiGVWG
CAUSE R%asu� a vyvy [.
Np yy.yp h.�y WE TO IOfl >5 A CO�EWENCE OF]
e�tWq �n M�W LoST
a.
VsflT L W�n aq�lv�i caWma [wOOwq �e ee�m W M r�vL�p n Cs wtlerryvp wse �rn'm �n Pan I 1& W>5 AN PUTOGSY
m
26 WLS GdSE PEFEWtED TO MEpCAI F]tAM:NE41/COPONEP?
ir.,erm� �� �
i9� CFATIFIEP
ccn.« ,�y
aKi
xse.
a�aww[or
IYU wml
i�W
CEFTIFYWG %1TSIGIAN IOtiY�� [w'WyY�O [ws� N Je�N �Nn �rW�p plry�s4n N� pMwCeCOwNW eMpbfMldn lD
ro w e.0 m mr Ww+�ww. am occ�,..e m. u m. cw.ecn w m..�... a.im
GFWl10UNLwG.wO CEPTiFWIC MvSG/�N IiTr+� eom amdrcM 0wr N cw�/r�0 rwnr d OuW
ra c. wa d mr �++.dw. a..m:c,..a a u. w,.. an.. w o�a..w aw m m. c.wd.I.�a mn.w u w�.a
�ac.iouMaan ❑ co� ❑ �. *�orsr.�n
LNwml�
Yrwtl Bx.�rn
Onan W D�un
xm. wn¢ aurovsr rwowcs
PVe4a8tE PWDR TO
COUP�EiKM10F �nt15E
KM
pF OEPiH> f Yn n roI
a� m. e.na a um�.nm w/> im..u�nan n r e a..m sa..w M w. mv. m.. d.ca w e. �e w w..to.�a cwr� ...uua
A �
% ' ��i'✓,'.�'� / i� !/' l�l � � �C� %� -� � //
]0. NAME.WD PDDPE$5 Of PEASON N'NO COMRETED CAUSE OF DEATH OTEM Il) ( Iype/RM
H7 ; �i.�iirnovv�x,ssiGrunme p� � �
Y 1 n:i.w /`' '� � ;�"3'�3 � �
7 �... i'� l J i
�� i^ 31 MANi[HOfDFATM )4 DPTEOFYiIUHV N0. iNFOF 'Stc. W,NqY11
'} IAImIA hy. Y��1 NJIIM <Y�a w rrol
D Ul "'I O N erJ ❑ P�M`q
�i .i ❑ ACtL�ti M�Ni1Wt1
lI R
C�' ❑ su�ce. ❑ caa �a a a�.. oucE oF w.ium—.v rom.. ivm w.n �.wn. ank.
y � 0.�Kme+E 4IE�G � t�Y�
H � ❑ Ibenctl�
ti �
� � .� SBHO60M Stete Form 10110 (R/10-87) �'`T�'u°��
]]. D�TE FAED Iwn� D�r.
Ni. lOC4iWN ISV�a aW WmDV e fi`tl Hwt� Mmee. Cry a To.m S�+i�)