Death Certificate - Sollman, George W_4/11/1989���%�.��--�'�—"'�`"' INDIANA STATE BOARD OF HEALTH
--•�--, , ,��•.I...... �ERTIFICATE OF DEATH
� H {
i I' �
n '� I. DECEPSED—NNME ' flil5i MIOOLE LPST
i 'I
;� i Ge or • e W. S ollman
�
8 �.�,. o.�. ��.. �.,...<, L1�
1 K � A YEABLPSiSEPVEDW G� RoCEOF�E�IrUCne[�
f R
�,,,u;�
� No . ............................
l
}. $E% 1 J
B:FIHR�CE
:�.cr.��w a �.�
�_ 1"__2'! l��i—
}rlleG�Ft�` � N�)
5 PRUEO FORCE51
> �+� ; ) ' MOS�IiAL. OINEP
�..� 1 OVBI� ]Q NW�nM ❑ EP/ONW�eN ❑ DO< —❑ Nva�pXOme ❑ Ref�Otrce ❑ QM�ISoe[.I�I
J � 1 ' O�Cft.l�l
� _ 90.fPCR1iTNGMEIYMniyuMpnfv�etwN�wrIDeO 9C.PlY.IOWNAALOC4ilONOFDE/1M 9� CW����
3 S
Deaco ess H ' „�.,. �and��r�bui-�Ei
U❑ 10 MPWLGLSiATU$—W�neE �L $Ufl'/NV�GS>OUSE Ib DECEDENi5U5UeLOCCUP<i10�� 1}p /tttp OF BUSWf55ine. ' R�
J rt n �... vro a. � � � eme�;]�IS�'{ED��u� 1`t6Hti. Packin
� a�3��;�,�Qa Riro�..��o�tt . �',a'��ai,y ES
7 rt
� 7
' W 1LFE51DENCE—SiniE 1]OCOUNLV IJC.GiKiOWN.OPIOCAiIW! IJO.StPEEIANDNUMBEP
"" Indiana Gibson Fort Branch R.R.2
�..
� .:n
p p U. W40EGiY IY.FPM� uq ZICCOOE ��.w'aSDECEOENTOF�u$PaMCOPoGVn IS nnCE—Pmmeanbaun
h'.�J i5](V/iPrc) fSCK/YNOwYI�.tlY1� /YCuNR A�nt. .
a� Nb Ye s � 76l�.8 M<.�.,, A,..�o,�M.��> z� �e o.., ti.la�:�e E�.,,
N So<cdy
�6 oECEDE::15eCUJa:�!
le[/YO"�Y�'9�'�n lbftti�a'_4+
i lv�ry [O.NI I GO�Ke 11.� w 5� I
Y• ' __
� N 1).GPIMEHSNAMEIF�[tAWG1eLIf0 1lMOiNEfl$N4MfIFVyA406'�Aflwtn$'nrw�[I .
h�
� Geor e H.Sollmar_ Hasselbri c •-
rt 7
Iya WF00.M<N�SNdGEIJype/��1 19C ML4WGhDONE55l5bMVbNUnOnwM1iM{bvxNVMe[Cfyata..rt9xeZOC.Mtl h9c�Mb�an✓ro
�' x z+ Rub Sollman R R
h� ~, i00 �PiE AND RPCE OF OISPOSItION W�me W[emelaY. [rtmatwY. d ]OC. LOCAiION—Gry ar iown Suv
G n !n }p� MEtMODOfD15GO51ilON ��
z �' � �euw ❑O^y�°^ ❑"'^'�""°^�'^• /�%8'��' St.Paul Cemetery Fort-�arich,Ind.
<n n�n O ow•.� O o�� �so«ay� —
< n Y
H'O 7 i�� S�Gtt>tlIREOfFUNEMLDiFECiON 31e LiCENSEMI�.fBFP Mli�O�v1,�1'1`�O`Psr,unera'fFF`I.j`omeF'I�1fi30020!}7
r, ,� � �, « � �
r o � I �,z, 9 r� - Ff�aYb43881 304 4I,Locust,Ft.F3ranch,Ind,
i' c � ! / G /• —
. ❑ � u._u
y rt H�) CPTP��� 4Ff 2L�C My , I]j� }O L�(fet� OI my WwllC�e. EYC1IXMeW �1 Nf VN. Gll �M GV[! �Y�eE I]JE LICENSE Ml�i9EH �H. D<�E 5� "
'Z Y� '*1 'V •n<nceN�T9e�>u�n�a U!xtD.r. �rnl
��q yo r-� rc...,�w. n m+. a e.m �e rd. <
1�!�.z�7 m ce�w> u�.. a e.rn ss�.�re s
�C] O � 3�.iIMEOFDE>iH �5 OPiEPHONOIINCEDDEnD[MCrcRDq.Yeul ]6 WPSC/�SEPE%EiwEDfO'/EDIC�LE+>it'Si'yCOiu:e.E:V
�io:35A .� � I � K`7 I,�.,a�,
0 0 (Z.r��.
��:: �
�'`r ^'� }). OPfli I EKn tX C:xuse5. nM�<4, a cor.4rtwm WI ocse0 Ne OtaN Da rol �ntt Ne maN W OY+`4. ��f [✓bx p nSpAwY
n ur�uc:eck«n..n1We.LUW . <��s.eneacn�n� . /� �
' n O'
o n �• SI�I\%YJ 1RY—
•,C (� � IMMEDIPiECAUSE(Fwl � y / � �/h.�1
�`L H .> Gsem w cwquen • —4"I__ •
�,� Z� �n�A�np n EmNI DUE, Oi IOP AS [ GOtt E UEN E OFI
'�� � �� 5muwrury�ncem�wm. e �l. �
y � M� k��ey �� �m.,���� DUE 10lOA A$ P CON pUENCE Oi) t
�..r�-� y � c.meErvnU�VEPLVWG _
.�7pr; H � CPUSE(Pnu�a�.ywy �- DVEiOlOP /C0.VSEC ENCEOf)
f{ Z I wi.w.ma vem. '•
��� � nwluqnauWLPSi a '
'•n-r O'. � VAFi 0 ane, wdc.�v cw�eam• cwawna ro e.m mn �a �e�wro � Ne �a�a•M•+a �.�•• c^.� n v.n i _
fJ
�
z�i
�\n p �.� 7s. cEPiv�[n
•1�� r, tCnsc� aNy
� e-] mel
..[C R
� �.'1
� ': . �
C�1
< 'O j
i� I
7 n
(n N
N O �}9b 51 i i
r �
r�
;z; G •�
—..._.�_ _ I W Nn�.RlJ:D
!-i N Jl,
Z �"
rr � ]I.FEPLiMOF
+ S �
7 � \
zti
�,. .i e��....�
a.,r ,z c. c�
� ^
}9e \•IPSGN[�Ui�G$Y ]PV WEf1El.U:[:v�...I:UU�t�i
OEfliON-'ED� A'/hR/�BIC V�110
IYno�rol CONRE�iO��O�C�USE
I�O OFDE41MV(�'vsnm)
� Ysciun� Yfcun
CEPIIfYWLMY51C1ANIPo eW1+�pfwudOUN�wineNeiG.t N�pawrceCCei���M[arrdeteOXem]D
io N� Nst W mY �m^irCOe. E��N oeewee0 Eu� le Uy uu�N�l �rtl errm�r �� sfa�eO
..._..._.__" _______"____'____'_ ____'
%10NWM1CWGA`IDCEFi1FYWGPNV:JCIPN(Glry'#WMNp'pwKFiO��'l�/nE[wE�y�[�useda.� .
io N. e�+� ot mr ��+eap.. ea.m occmr�e n N. um.. ab..M W<...M M. �o ua um•41.na mw�n u nnea
..._....._...._...._ ... ........................._.__—..._.._.._...._...._......._""__""...—'_._..__...............___...._._._._......................__.......—.___..___...__.._
MEDIC<L EMnuY:ER ❑ COAONEP ❑ NE<liM OFFICEH
On N� W V f W e.lml�YT �M/n M'� WG�� �^ mY �G�� 4�� aCYrt�O rt Ne IYn�. E�le. �M Lbc�. �M N� �0 Ne c�ufal�) �M m�mee �f s1,1M
CE 19cL�CE:�5EM1n�BEfl ]9� D4iEYGSO•k•'-^.M..Y�rl
� �.. ,, , . ,,u � , 2 70 3. S� �{-- 3— �
n00NE55 OF GE1150h �O COM0.ETfD CaUSE
yLNATURE
� � : U. MAN' P DGiH
• µ
7
❑ �.N O v� a
G I in..r.puan
m ❑ e.cbs�+
. t,, O 5�<. ❑ Cawe � e.
rT ❑ Heackr . D•��rmnee
7
� SBHO6�00< $ute Forr.n 10110
£ I
� 9 �, p � � �..
JU OGiE Of INNHT J�0 i1ME OF Nc. VIJUPV Pt
WaYM1Oq.Ywl I WNPY IYndro)
J4.0.ACEOf WNflY—Al1am�.b�mrv��ll�ttwY.cMC�
ew.q. r�c <svrcir>
Fev.10/BI o[�*WVO�
"Indiana
OA�E fM1CD letxl D�v. � rv)
n,. , C �l I �: (�
l.a. o[SCPoBE no'.v w.lunr
o.i. ioc<rror, �m..� .�w .��, > ......o,....,......,,.,. _ .__., --�-