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Death Certificate - Siegert, Martha P_8/17/1971� _ ' `. , � , � . _ . . . ti �. . _� . � . . . . . . . I " . . . . , �. . ' ' _ , • ' I ' ' ' TYPE OR PRI\T a � • i . INDIANA STATF. B0:1ItD OI' IiRALTH � � � "' . seH ���_� 'I �Lal\LY ��'ITH p; , ' �, ' DIVISIO\ OF �'IT.1L ItF.CORDS � � �� UPER 1� tXT� � � L5[E0. H NOBOON IOR.•.CE�kA' ED—NAME ♦I^.T �IEDIC'�M'oo ER�PII'�IG�TF, O T �DE', SEH DAIQ Oi DEAfM IMOr�iN. oN, v[��i.�^•.—_ II INSTNULTION$ I RECORD �} �. 1• bfARTHA PAULINE SIEGERT � � �Femele �. Januar 12, 1971 il �,,,6 RACE wNrt[, nccno, �w[eicer� woun, AGE--��y. unocn � yc�e orvou i osr OA�E OF B�RIN COUNtY OF DEALM ' I ITC. 1{�CCII�`� •111TMy •Y �Y[.�1��1 MOS O.�YS NOUN� YIN. �MONTM, O� . Y • I e.�,. ro. s�.�. oe�� c.. � • �, � Wh1L@ s,. 04 sb. 8 10 s�. a. t•Iay X2� �� e. Glb90ri �� ' i , . CIiY, 10`/+N, OR IOCAIION OF OEA7M iwsioc n�v liwrt� HOSV17Al pR O1MER INSIIiU110N—NAIdE �n noi n. u�N[n. 6rvc srs[[i w�n nuw�te� . �' i � '' � u�[u r r[a o� no� � A �� � D[CGSED �s� 'Princeton � ,�, fes ,,. 530 South Hall Street ' . i �'' ' $IME�OF BIRIH �i� qOT in u.a.�., CIiIZEN OF K'MA� COUNfRY enAR41ED. NEVER MARRIED, SU4VIVING S�OUSE �iiwve, erv[ w�i0[n n�wb H . �' . M�u[counr ♦ W�DOWED.OIVORCEO Isr[c�rn I . A� usu,�.cs�oc�cc ,. filinois o. U.$•li. ,o. Married ,,, Herman R. Sie.�ert Q wane occusm :� {Yij �*I liv[O. v O4iH SOCIAI $ECU4IIY NUAlBE4 USUAI OCCUVAIION �61v[ KIe�00I wOwK OOM[ ��nirvG KIND OF BUSINES$ GR IN�USI4Y � OCCOPPW IN I MOST OI WpNNINC LIFC. EVCN I! RETIREDI � ,I IH3TITUTION. OIVL ' ^ � .csmcnccecronc "� N A ��0� HOU824l�S@ i76. ci rl� i � nowissiON. WiSIDERCE�UIE COUNIY �IIY, IOWN OR IOCAfION �� �r�uoEU�v unrt6 10WNSMIV '7' � ' IVCUirr[^+Owwo� " . I F „ a ,.,. Indiana ,,,,Glbson „�, Princeton ,.,. Yes ,,,. Patoka � (y� 519EEi ANU NUMBER � . _ W %. IS RESIDEVCE ON A fALA? � w ,.,. � 530 South, Hall Street �• �y ! F , � I�q. YE3 ❑ NO '_A i , a z fAfHEC—NAAIE qwPT , w�pOl� 1�3T MOfMER—MAIDEN NAME IIR6T w�ODI[ lwiT � c °� � VA0.[NTS ,s. � Ellie Rile Wa �e. ' b?aude (urunown) t�ic?labb I � i+i rl INfORA1AN7—NAME . 9EUIIONSHIP M�IIING ADD4ESS �sia�[i Oe a/.o. no., U�v Oe iOwn. s��i[. ii�� � p� ��a.Herman R. SieRert „b.Husband ���530 S.Hall Princetor_ Ir.diana � � . PARi.II OEAiH WAS UUSED BY: �EN(ER ONtY p4E UUSE GER LINE FOR �ol, Ib�, Ah0 ���� q'1''�is Q�'*E in*cnv�� 'i OET`YE� OrvSET �rvD DE�iM i � IO. �MMEDIATCGUS[ �� � � � C( ♦ � J � . , �o� �� '-�-. l t-i C Fki` (� . o- . �, i u ..� � S�-�^-.,` - . • COrvpR10N5. �F AN1, OVC TO.OR .�v 6 CONVEOIlENC601: • ' ' i W111CNGAVCNIi6T0 1 �� �� , � ' ��wcoi.i[c�ust �+�. Ibl �� �� �'�-CYJ-'� �i-O U--�. VO S � S � l �i I �` 4inTINC TMC V:D[N. DUE TO. OR 45 A<ONSCOUEN<C Oi: � r . � LV�NGUU9[L ft (� . � �. z r! uus[ �� �<� l'[a,r �o �' SC. �M I^1 ��n�v.S/vP �s�PQ` I�'� S �. � � pARf II. OtHER SIGhIf1UNf CONOIt10N5 COe�olilON4 COe�in�aui�NC io oewiN o�i oi wel�i[o i0 e�us( AU�OVSY If YES wENE i� oiNGS eON• � OIV[N IN P1NT 1 �A1 � C �YCf ON NO� SIOEPEO IY OCTE4MIMINO . • � . � � � Q , � � l 1, uus� or ourH � IPo. lY� Ivb. ld . " . . ' .. � W � , S_ y OUTN�OC�URRED iHE DECEDENT WAS VROHOUNCED DEAO ' DAfE 51GNED �HOwrw, ' v, rC�n1 . `f,� (NOUIII 40NTN DA• . w Y[IJ1 NOU11 � �. f3:4 Pu. zos. Janusr 12 1971 ' ,,,:_ � 8�—�� ; CERII�IER—l1NAE ITYPCOPYNINTI $IGNAfURE . CaR O i�TL[I C[RililE4 .� ' � / � � no. Lr. Bruce C. Brink, D.O. ,,,. � � ' �. MAIUNGADDRfiS—CERfIHE9 sM[�iOwe,�,D.HO CiTYOeTOww •r�rt x�� a �:. ,,. 410 North A;ain ,, . Princetnn Indians 47570 . ,BURiAI', �aEMAllO'J, REMOVAI CEMEIERV, CREMAlONY, NNERA� NOME LOCAfION ��tY oe rown •r�re �UNIRAt MJM1�E KU.��9:R ' QS ' ��r(cirr . Dinposition-Permit � C� � ' z'o. ��urial �;,,:, Graceland Cemeter :,�� Albion, Illinoie 56� IMAptd �� .7 ,pUR1Al DAfE ��wowrw, owr, vun� NNEYAI IIpME=NAME AND ADDNESS � [ O� TOwn, 5���(, i�/1 I'rovixional ''�'"' ' -•S� `��t�l�iF��il . � ,.e. �an. 15, �971 ,5„Kondflll F�zrieral Home..:- � Crrliflcate w -� � - � e on Indinna 4� 0 ❑ YCw ❑�O '� �.�• . iU�N ``"�°'" f,f09—SIGlJAIURE /' .; NEAIIM OINCCR—SIGN�TUiE ' ` D�If FEIUVCD DY lOiAl NUI�N VIH�E4 � � ��Y`_ lf—.Q�Y__ �G ,� , . _.. ' �