Death Certificate - Robberts, Marilyn K_5/17/2012INDIANA STATE DEPARTMENT OF HEAITH
CERTIFICATE OF DEATH
State No
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❑ Nouire Famry � DececenYa Mame ❑ Nursm� MarcM1m4h^� Gre FatlYry
� Yes � Na ❑ UnW�w�n ❑ inw•�iem 0 EmerpeMy Dew�m+em pu5s'iem � Deaa an nmvai � Omer ISO�uM
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7539 W. 47TH STREET
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IASPER. IN. 47546 DUBOIS ❑'��e ❑ n�...u..mea ❑ u�t�o.,�
FRED ROBBERT;
ia. aevee�,ce.suro
INDIANA
1BC. S>GlIAMNYTClr
NJ. 47?H STREET
HART
❑ durial 0 Crtma.nn Q Jonabn Q Enlom�r..eri
❑ Pemoval Frpm Sp�e
❑ Yes � No
DUBOIS
NOT H�SPANIC
47TH
INDIANA REGIONAL
FUNERAL HOME. 214 E.
IN 47546
� Yes ❑ No
cause tn veam ��ee mawcmns nna czamp�es� ppprozima:e
29. Pan L Enter TM Cham 01 Evenb - Diseazes, Iryu�ies, Or Cwnplicatqns - Ru� �vecity Caused Ttw DeaN. Do Not En:er Tertnvial Evenb ��terval: Onset
Surfi As GarEiac Mes4 Respva:ory lvrest, Or Venriwlar Fipnllation NA:MUt Sl�ow'vig Tt�e Etidogy. Do Not AbCreviate. Em.er ONr One Cause On To Dea:�
N Lme. AOE AGtllv�al Lines If NBCt55dry.
M.. eEU;e Cause (Fral Disease Or CoMNOn ResW:vq N peatn) A ENDOMETRIAL CARCINOM4
e i �.. c...e+�
SepueNiaAy �ist CaMiuons, I( My, Leatlin9 To The Causa listed On 0. METS TO LNER Y
Lv�e A. Enter The UrWery'u�g Gausa (Oisease Or 4yiay TMt Initia;ed �� ���
TM Evmis Resu:tvg In DeaN) Last �
mi n......o+e .
D.
an P. En1erOTer54rv5ca' CaMhmf ConNMPina 10 Cel:� BN NW RGSNGg In Tlie Uewe�y Guie Grvin In VaY.I $9. Was Fn A�Sppry PertOmeE? � YES � NO
]0. W<rt Au!oOSY FvMVp AvalaCle io Completa Tt�e G::se Of DtY.�] n YP� [! Ho
J1. pi�TaOa�ooUSeGOnY+OUteT00lON? Jl.IlFtmalG: 3J. MatmetOtDev:l[
� Ye5 ❑ PmEaW) � NO p UnYnpwn � wn�T�nvrtmamr�v ���p�r�uimaCrn � wnquiteun�pynvana.'qap0.n � Na1ra1 Q HOmrbe ❑/¢o0ln� ❑ PenEinplmesugaWn
❑M.».�..ia.n.owuo.n..�,..�..n.o.a+ ❑uee.,nA.w+�.�.o....., ❑s�daeOwweNweeoe�emwee
x. om.oro-,py�u�:voarnop 35. r eamr,n �3. �V�Otlryury(E.G,DeceEer.[sHame,COnsWqronSlro,Restaunnt�MOOetlNrea) az �i�,.yuwone
❑ Ves ❑ No
SIGNATURE
BARBARA PATTE
WAFLART. VIA
IQom.uaov�v Qn�qr Qwsm. �on.ISO�WrI
COfLbH (GIiKkONjQ1C)
Certitnm Pnvzirian I-1 Caroner .❑ Hea'l.0°_rer
AiiENT10N ESTATE' The Sorial Senrtily # is beirg repueSteE by Nis state egency in ader to Wrsua respansipiuly_ Discbsure is voluntary ard Viere will be ro penalty tw re:usaL
