Death Certificate - Robberts, Marilyn K_5/17/2012INDIANA STATE DEPARTMENT OF HEAITH CERTIFICATE OF DEATH State No t0.11DeaNOUwreElnPHOSOiIaI: IDa.IIDeaJ+Ott meSOmewTemONerTnanaHOS:iat ❑ 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 H. Fa YtyNimO (IINWIn5�W4rn,GiveStreet�nClNm�e� 7539 W. 47TH STREET +2 UYaTa.n,sb:e.tmzroCOae u CounYOiDea:n ta. Mamms�aw:A�r aDeam �MameEQM.ameE,&nSeW��� ❑�o2W 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