Death Certificate - Schmitt, Eline N_7/8/2011No
N
CERTIFICATE OF DEATH
State No
535438
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❑ MosOCe Faz&tY � DeceGenCS Home ❑ Nursm9 ibneiLmSRm Care Fm3ry
❑ rrs � No ❑ unknw.+� ❑ Inpa�ient � Emuqency Depamnent Ouba�mt O oew oo a�+i p�,a (s�,y� .�
6734 SOUTH 950 EAST
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❑ oaia �soeayc ALEXANDER MEMORIAL PARK EVANSVILLE, IN
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� y� � Ne ALEXANDER FUNERAL HOME, WEST CHAPEL, 2100 W. ILLINOIS STREET, EVANSVILLE,
ini no�» FH'I
❑ Yes � No
ICHAEL E WITTENBRAKER BY ELECTRONIC SIGNATURE IFD01024459
Cause O1 Dwth (Sea Instructions Antl Eaamples) Approtima;e
28. Pan L Enter TTe Cnair. q Evenis - Diseases. Injunes. Or Gompliwtiass - TTat OireNy Caused TTe Deaih. �o Not Enter Tertninal Even6 Intsval: Oreet
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A Line. ACO Atlaiunal Lines tt Necessary.
Mmeaiate Cause (Final Disease Or GoM�'ron Resul�e5ln OeaN) A. ALZHEIMERS DEME'+Tln <���
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itre Evenb ResW'.vg In Dea'.t�) Last C.
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Yes � No
❑ Ves ❑ PivEaM' � No 0 Unknwm I �.ue.w�wu.�err.. � ��s+�+n�r.,.ao�n � �vnm•�aewnv��we.��:omwa.e I� NaYRI O HortwOe ❑ AfaOLnt ❑ Gaititglnv'Sli9&m
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BRINK
❑ Yes ❑ No
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3795 ATTEMqN ESiATE: Ttie Social Sewnty x is Ceig repuescea cy Ws state agercy in «tle. to W rsue responsiDi4ry. Distlosure is vdunary aM Nere will Ee no pmalry fa re:usel.
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