Death Certificate - Spindler, Dorothy_11/2/2011n.in�n�:rtniu�nia�nuannr�itinno.u�w.�.:�u'a.�unuu:��m��snu.��..:unn. nu:o.ru�.�..:u.. i.�...��n.:�..�m
��� INDIANA STATE DEPARTMENT OF HEALTH 7 H 2 7 7 2
CERTIFICATE OF DEATH
��j Local No 001968 EDR No 000000225375 State No 046171
t oeceam's Lepal Name (Frsl MiOCIe, Lan) ta. Mdben NarM (It temae) 2. Su 3. Tme ot Dea:� a. Dxe 0t hun (M«arwayneap
DOROTHY I SPINDLER MEMMER FEMALE 08:45 PM 10l22l2011
5. Socal Sawny NumOer Fa. Aqe � Yn fiE. U`ber 1 Yaa 6c. UnEer t Marc.� 80. UMer 1 Ory 6e. UMer 1 Haur ]. OS.e ol BiM (MaCNDaYnear) 8. Binfpace (Gry eeW Sta's v Fpeign CanTn
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❑ Yes � Na ❑ Unknn�n ❑ Irqa'�eN � EmepmcyDepammentOVye�em 0 DeaEmPmval � Hos�iceFecdty ❑ OeuEe�v'�Mane ❑ NunvqY.melLprfbrtnCanFaaLy
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11. Fa<3ty Name pl Na NrtEtJo2 GNe S7aet mW NunRV)
DEACONESS HOSPICE CARE CENTER
13. Ci.y Or Tv.m Sror, Pra Zip Coae 13. Cou:.y O: Daam t<. Mantal5'aU A� Tme OI Dea'.'M
❑ MamM Q MamM, d�t5epaza:eE ❑ Oiwm.V
EVANSVILLE IN. 47747 VANDERBURGH �+�+�� ❑ NevetMaineC ❑ u�w,a.,,
t5. S:i�mAepSpousa'fName 15a. QIYA4�('ineMaqen(astName 18. DecCGenl'sUSwlOatps;ion 1). KudCQ9�ssxsYlMUSYy
SUPERVISOR DIETARY
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INDIANA GIBSON HAUBSTADT
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10997 SOUTH 200 ROAD WEST ❑ ves � No
47639
t9. DecMenf�EEUU�on A. DacMentOlHisparvcOngn 31. DacWan[�Pece
SOME COLLEGE CREDIT. BUT NOT A •
DEGREE NOT HISPANIC White
23. FaLYeb Name (FVS� N.itlme, LaSU 23. MoNefs Name (FVS� N.iEae, last) 2]a. MoNeh MaiOen Lazt Name
GEORGE MEMMER MARY MEMMER MAIKRANZ
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ROGER SPINDLER SON 2179 WEST 1125 ROAD SOUTH HAUBSTADT, IN 47639
25. Rau p ' si5m
]5a. MeNOC 01 Disposi0m 350. Face Of Disposloan �Name Ot Cemetery, C�emabty, ONe� %ace) 35c.lom9an- Gry. Town. An0 Strte
�&1131 Q GGmYAn Q DO(N'.VII Q FJCVfi01nM ..
❑ Rertaval From Stata
❑ on,�. �sarom: STS PETER AND PAUL CEMETERY HAUBSTADT, IN
26. nhs Camer CarcaaM'i 2J. Name Mq ComqC,e ne0ns� 01 F�ndal isofry Pa. F�nrN Haie ticense Mxnev.
❑ r� � N° WADE FUNERAL HOME INC, 119 S. VINE STREET, HAUBSTADT, �N 47639 FH83002990
2]0. SignaMe Oi IMaw F�nerd Se�vice Licensce: 2]c Lit nse NunEer (p Ixensee�:
ALAN J. WADE , BY ELECTRONIC SIGNATURE FD01017080
Causa Of DwN (See ImWCtlma Antl Eiemplo) q�px�a;e
28. Part L Enter TTe Cham 01 Evm�s - Diseues, Iryuries, Or Complicawru - T1w� Oveay Causea Ttre Death. Do Not Enter Terminal Evants Intervat Onset
Sud� hs CarEiac Mest Respea:ory Mas�, O� Vercrwlar FiOrtllation NA:liwl 5lvwvig The Etiobgy. Do Not AEGevia:e. EMer ONy One Ca�se On To Dea',ti
A line. AtlE ACd�bal Lnes If Necessary.
Immetluta Cause (Fnal Disease Or Cpqilion ResWtvg In Oeam) A RESPIRATORY ARREST IMMEOIATE
b�V Y�GVO+ro'J{
SequerCiaVy List CoMUms, It My, leativg To TTe Ga�ae ListeC On 8�
Lv�e A En:er Tha UMerlyrig Cause (Diseau Or 4(vy Thet Ir.i�a;ed �'""� "`O�' �
Tha Events ResNling In DeaN) Las1 �
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PM IL Fn'er OnerSqr�iSw�t Coeq�ans ConMd�Sna io DeY.� &M1 Not ResW:�q In R+e UMxlyi�q Cause Gi�in N Part 1 I9. VJas M Autopsy PeRdmeUi � ye5 � NO
IUNGCANCER JO.K§nAV.opsyFeqvqA'�aiadaTOCanpY.eiMCauseOfDeat�i Oyes �No
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I Se. Da:e q Iryury (MOnCJOSyIVeah 35. Tv�e Of Iryiuy 38. Plau Of Iryvy (E.G.. OeceOaM's Hane. ConsWaon Site. Respiiv�t `hbWeC Area) 3]. Iryuey N NbM1?
❑ Yes ❑ Na
39. lxatm Of Iryvy' Sab 32a. C4y U Twm 3E0. SYeM 6 MsnOm 38c. ApL No. 3BE. li0 CoEe
I]s. oewieenox�M1+arownvc ao. �lirx+w«•s.+u�4+l+r. Y.
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Ia�. Synr re. olParsonCm'�+YOqGuzeaDeaY� a2 Cer_w (Cnetlipvia+a)
�RRY WILLIAM LUTZ BY ELECTRONIC SIGNATURE � Cer..y'uqPlrysioan ❑ cormer ❑ xeamo-xer
e3. Name. NEGasf AnE liD CoGe OI Porsm CaLfW�C Cauze d Deayti a4. Lircnze Mmeer <5. Da:e CmufieE
LARRY WILLIAM LUTZ 802 E. OAK ST., FORT BRANCH, IN 47648 01027538A 10/24/2011
a8. n0caontlF�uixbSaNCaRV�ieer. a]. •nkas:
<H. Si�naNroof WralHea"tiO3rsr. <9_ ForReqiatnrOnly -DaaFJeO (MmYJOaylYea):
RAYMOND W. NICHOLSON, JR., VIA ELECTRONIC SIGNATURE OCT 24 2011
AMENOMENT TO CERTIFICATE OF DEATM (ENTRV OR ORIGINAL�
Sa's Fwm 53355 AT'fENiION ESTATE: The Social Seanry tt is bevg reques;eC oy ihis state a9^-MY ��� to purs�e raspansS�tity. Discloswa is wlun3ry artl ihere wdl be m pu.atty hx re:usal.
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