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Death Certificate - Thorne, Richard D_12/1/1994�� t �AT'fEHIION E T`ATf: Oisdosure of t�e SSR M+.�y�na Nere wJi be no penal'ty1for isvalunt(• � INDIAI STATE _DE?ARTMENT-OF-HEAL�• - - � � ,er„� • �,���= C/�� - Local No. .........��..! ...... 1... CERTIfICATE OF DEATH State No . ........................... TNE RECOqDS W THIS SEPIES nFE CONFIOENTIALPER IG t6�-14] TYPE/PRINTI� OECF?SEO-r:nuE IF+nbbu�uw I1.SIX IL OMEOFOEPlM I]eJAtEOFOEP�Hnnnp.�r.i ��e*_= �. `?":o� :e uaie Jas.�. 25 IN 5:00 P � 'Y , =55� PERMANENT �����SECUPrtYNUUOEP 3� >CE-uv0umery 1 a UNOE9�vEPF1 X UWEP�OPY 16 DaiEOF91HiMIMepp,vrl I.9NiYqp�E(Gry�+eSUrniceq�Cwrvy� �..�o� .�„ o... ro,.. .�..<.. _ � - t� �� BLACK INK � � AliG 0, 933 :.aze_�on, �i g� Nn5 uECEOENi 9p vEiR LaS: SEAVEO LV � 9� h_nCE OF 9EdiM fGsc. mn me jer nmr.��pwn1 aU5`/EiEPiN+ U5.<RUEDFOPCESt OSRieL � Non«� O�rE4 C exr�.q��m�a ❑ pw.�5o�e/yl NO V�A L' EelO�acsw� DOS I r' Aaewc� ge.FafjUiVt�suE(p�vnrmmnpv�crwrq�wror� 9�.CITV.�OwHpq1,OCAiIOMOF0E1iN 9aCDUNiYOFOEPiH DECEDENi $L .�-' ^i0:^.V � S i?2C:_� Cc1 C.e^.L2" I CiOFIP. ?O' ^L I� d}C2 i0 �PoiaLS�+�US u.SUrNVV+GS�'OUSE uaDECE0Ervi5U5UeLOCCUGSiWN(Gn.md.v. in.RWDOF9U5wE55AnW5:Rv '-u`s.cv`'�2C. I T'TS�'II s �l':�JOP_T?SOP. I?��Si:S:C�."'�'.ciS.cC��•••'•" I iNY�1L2C0 L*1C1iSL__2S ik PE40ENCE-STaiE Ib. COUNrv �iG CITY. iQ'NN.OPIOC�LION 1]e. SiREET>NONUMBEB I�c-ana Aie:�r o� I She �.,^y I?ox 152 ur Z�iC00E iy. WS�OECrtYJ'M� i5 1� CITREVOF i5.'.va5C� EDENi0Fnr5P4mCOPoGw+ i6 MCE-:msc�ninnn i:.JECE0EVT5E0UC_:iON �Ve �xl'n 'xnaiC'JtWiM+ ���iy ,,, Nr„.w�caYGUn 91�c�.wM�e�e ISwclve+ynqnenp�wcu-an�9 W�un Tmv rbcn e¢) (Swc/Y) I Up ON P FnPoU) I I i'�rwv/v/SNauvvl?�II I Cbep�U.aw 5' 1 963 i7 ,�„ ❑„„ uSt Nfi.it2 12 PARENTS �0 F1RfER$ NiME (FrR MOa�. liN 19 MOTFEA$ N1ME ffi¢ i.V,A M� yn��r�e� VeL Thon P.uclie ' �INFORMANT � w�Oqu•e�.-S.wuE <::oeiT+e - x0e weRwG �00PE55 t5vm.ro'nn.er n.lrrAw. nurror. C�. u re�n 5s. c.a Gea� � M���.� Sue '?'hone I Box i52, Shelby, �i 46377 Iiicn�ower .x a.wa, » W1=^c 2��i.�E:�ODOF�15Po51TION !'E�eaww�n llaOnTE�t�OR?CEOFp5iO51IWNL�Wrrdc�rrrt�ry.v�mmyw 1�c_OUTION-Cryw�o.nSa� ro d�. c�,.�, ❑ a.�..,,�,�. ��°29 � 99a �ni �v.:'i� r D a.� i� � o�, _ ��5.,.d.� �lJ�._LL .._ C,eT02�8'_'�j e�__sburg, �V DISPOSITION ��• E'�%'�'"�sNn.� m eMe•werrsu[er+seno 3J.'Na50EAiHFEPOPiED:OCGPONET+ Mv��LJ PS1GE?rSZ^. '�OZOO�JZOS L�+. e ❑ vn z��51G`�R�nEOFN LOWEGiOn T�e.uCEYSENUM9Efl 2S_.tWF.:^ ,.r+puCENS�nVUBEliOFNrvEUtnO�.�E (a/4�m.) O-J � J,J i��.�J-��� �'� ' ?�01000328 ���5�'�e�� �`-o�. so i�, �ti4o307 CAUSE OF DEATH CERTIFlER :Q o.m i . q..a..�«-_ _ � - - ° �a n. <..a. o> � M. �<<.,,�..,,�,... � a ,.,s.�,. _ iNi� � •-- ic�ciSi6Rn ' 'a�. �.'«.",w �J�.�hi'�`.a.w�c'�1��':.._ ' i.�.awr� c:uuffa.ON EILE NlITH THE IAi(E C011�'T'.� „ fl., u/l c c[/ L-� c C4 .� �� � �� °����H�TH DEV�.i. � DUE TO (OP CS s CONSE�UENCE O� n Cyamyn d v�. +i+u� pn. OUE TO fOP 45 � CONSEOUErvCE OF1 ^°m°""'^°•.°,.. t.4AR 14 199s+ mw ��� � WE TO cOP n5 n GONSEpUENCE OF1 cw.. ua cant n onw - - ,,:,�;_ c��c:�n-wa�rti coNaetss��� =ro�m+•o w.nu er....n o�...� o.m, v..w..r aa.a n o.n � _>. wa5 oc[mwr xe. w�s u+ �urovsv xm wFtE auronr �nowGs iNEfNU+r oN 90 oav5 PESFOM�I �vLLABLE i!bpP ro iOSTVWiLM1 fYw>ml COMiI£IIONOFCAUSE _ . _ cr..>.m. . __..NO _. _ _ ovc.s�.�r..rv.,a.:r_ VV xs. cv+nFlEn !LCw1�F�'wc wvs�wu+ ro n. e.. d mr �•^�-»aa.. c..m em...a . m. en.. m. w ouc...�o w. n m. c.iwn...ma tGw an ar� ❑'+EALrM oF�cFA ow aw m a...�..oan me�e� �...w.� � �n ao.�an a..m «anw w n. mr_ a.u. ca ew aa o. m c+. c.w�a� a.m.a ❑ GONONEA On n om a� �.r��mm �na/a ...�mw� ++�n oo+.v� orn xavr.o a n� mm. ean. ue oyc�. wa aw o vn cww�to w rnwy u m.a ]9e SIGNaNPE �n0 nRE OF C WfF�EA � . I 39e wEDiWL tICENSE v0. I]% Oa� SKMD I.�an O�y. vr1 )p. Na�E selp aoDaE55 oF ofA50H HEALTH I ��. nEatn+or�t:A59Gwwtu� ��C� r�/Wt�Eei pF OESiN 1.i�4vY .� iMr9va Lr.�pj�pp� � iC[Yw� � Srn. _I CWCbe� [ nm�na. Ow��w OF OFAiM OTEN �11 J M ]v OPiEOFwJUm ]u �IUEGF :K. WNfi'ISiw0iC1 Na DESCPoOEi+Oww.ulvOC���D J (Abpt WY I� INNflV fYnoral v J�w N.nCE OF iMNnv-ai ncm� Ivm ave.a I�cm.y. omc� I:u �p�qPON (SV�w w Mmo� >�1re Fain� wnur. GN u� o.n Sirt�l '+ov .c t5o.r/H JniE Go0N0UVCED OESO (AMm C��. rwy � yn upTOX vENiCL� aCC:OENi+ IY�� o ro! �/ Y�a �pc/y a�wr. o�. aemn e¢ SDMOfi�00a State Form 10110 (R4/3-93) Deathcer/PD I r...� P