Death Certificate - Sheridan, Joan E_5/11/2012CERTIFICATE OF DEATH
Local No
634147
Forwi t0.1/0wN Oaiare� N � F1mpW. f0a. H Dea:l� Oca� SameMiert ONQ Th� A Hosdb�
❑ Hospke FaaLry .� DemCmfs Huna ❑ Nurs'ug Mome/Lm¢�ertn Gare Fac[ty
❑ va � No ❑ Unknv.m ❑ InO�eM � EmagmryDepartment0u�ent O oamm.nnwai p omerlsoaxyl
1308 EAST OHIO STREET
is. o�aae,ro ea�so�
SOME COILEGE CREDIT. BUT NOT A
� e�.w O �� O �� O �++��
❑ ra� c�cro sra:�
ST JOSEPH CA
❑ M�o O n�mea. an swr+•.ea ❑ a�ac�a
❑ Wkov.eC � NeverMartieE ❑ Unk-A.m
47670
�
❑Ya �No
❑ ves � No COLVIN FUNER4L HOME INC, 425 N MAIN ST., PRINCETON, IN 47670 FH83005671
]p. SiqniY2011n6anaFUnCdISCMCOLimisee: 2]c LicmuNUmOa(OILkM5tt1
�ICHARD DEAN HICKROD BY ELECTRONIC SIGNATURE FD01012153
Causo Of �eaN (See InsUUCHOna AM Fsamp�ea) qpp�a;e
28. Part I. Enter The G'+a�n d Evmn - Disrases, 4yur.es, Or Comp6wtiom - TTat Direaly CauseC The Deat�. W Na Entu Trnninal Even� �tima�� �nset
SuUi /u Car6ac Nrest Resp'vatory Artrst, Or VenviaAar FEnOatim NhNwt Sl�eMin9 ihe Endogy. Do NW AOO�e�ia:e. Enrer OM/ One Caiae On To DraJf
A Line. P40 AECiWaI Lines It Necessary.
ImmaCiata Cau58 (Final D'SeasB Or COndi�on Res�dutg In Death) A ACUiE MVELOCVTIC LEUKEMIA >> ��S
a..� a
SeQUemiaOy List Conditims, If My, LeaCing ToTha Cause LiSteE On B' „
Line A. Enter Tha UnE�ing Cause (Disease Or 4q�vy That IrvGateE �e� �
Ttie Evuib ReSWting In OeaL�) las� �.
<�o-...
D. _ _
❑ Yn ❑ PmEaNY � No 0 lhiimwm
THOMAS M
.w. wemnmw+vruiauv� a.�.a ��...�rv�ne i�i�..awo..�.,�..��� � Vrs ❑ No
12. IfFemale: �. �^^g��°�:
❑ wn.�.tiwearmr..� � ny�wui...ao..s � ren.a��a�o�w+wcti���wnwu.w � W1210 Md^+rl]e ❑ AcdOCn� ❑ Genanglnv'sngatlan
1-7run�r�+a.Aro��ao-n*e�r�e.r.o.s� ❑u+�v..�ww+ww.�m.v.�rr ❑SUrciCeOCadONdBeDYSmJneC
Crn:c
Catmc
DEC
❑ YPS ❑ No
Qar.�eo..a�l
tate Form 53395 q77EMqN ESTATE: The Soda1 Sea�ity # is beng repuesle0 Oy Uus state agerry in adar lo Wrsue responsibsry. Oistlosure is vduntary eb inere wio oe no penmry �« rruszi.
^ ' NRA-20
- (7/OS)
. . . . . . � . . . . � . . , . . . . _ _ _ i . . . . .. . . .. .. .