Death Certificate - Rietman, Ruth Lee_11/14/2012CERTIFICATE OF DEATH
Local No
896637
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� lbspice Faatiry � Dece0en�5 HanO ❑ Nurs'cq Mqn^�LOnP�^ �re FiCIry
❑ res � No ❑ unkno.�n ❑ iwxen O Erw�c�n'owa�,eaax��� � owaa�nmvai p oy,glscawr�
706 HULL STREET
19. DecaCmCS EGra:ion
HIGH SCHOOL GRADUATE OR GED
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❑ Remwal Frvm 51a'.e
res � No ,
ADT
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t06
E PARK ST HWY 168. FORT
IN
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❑ Wqow.a ❑ New Mvrca ❑ unaw.m
� ves ❑ Ho
. �eusa ut ueatn �xe inswc[rona n'w uampies� Apprpumata
28. Part I. Enter The Cnain 01 Evmn - Oiseases, Iryunes. Or Camp6ca9as - That Oirealy Caused The Dea'S. Do Nd En;er Termv�al Even¢ Intrrval: Onet
$uM 0.5 CarCiac Mest ReSpva:ory Mest Or Ven;nwlar FiCnOatim YhJrout Stiow'vig TTe EOdogy. Oo Not Ab WeNa:e. ErY.er ONy One Caisse On To DeaN
A Lina. ACE AEd.vwl Lines lt Necessary.
IrmMia:e Cause (Final 0isease Or Cadi.im Re5iA0ng In Deat�) A. Pl1LMONARV FIBRQSIS LONG STANOW
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SeGUen4aAy list Cone::ians, tt My, leaaing To Tl�e Cause Listea On B' ,
Line A. Enrer The U�Wertyinq Cause (Disease Or Injury That INtlateE �� �
Ttie Even6 Rewl;vg In Oe%J�) last C.
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VONE 30. Were NutoMY FiMinB Awlade To Comqete The Cauu OI Dea.�? ❑ Ves � Ni
31. OqTOD3W0USeCan�df,eTODeaNi SL. I1Female: 33� MimcO��eafh:
❑ ra ❑ P�madr O No � uow�wm ❑ µ•"•°'+w••1'°�••• ❑"•'-••�r.�.ao�., ❑�un.o..�eN».P..r..,n o.,.ao.s, � Naaia� � Homicae ❑ nmam ❑ amaig �mestgaoa�
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J/. Oaro Of InN�Y (MOnttVDafnrar) 35. Tune Of InN�Y 36. Place 011njury (E.G.. DeceOmYS None. CansvucUOn Sce. ftestaumL woa0e0 hma) 3]. Iryury N WM?
❑ Yes ❑ No
9
WAYNE SASH . 3801
Q�ISO.arl
1
i3395 pi'7EMION ESTATE: Ttie Sadal Secunry n is �eng reQUesteC Ey t�is state agency in wder lo pursue responsibbry. Disdosure a vdunary aid Nere wW Oe rw pmal.y for reLSal.
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