Death Certificate - White, Norma B_8/17/2011�. HAMILTON COUNFY
11 HEALTH;•DEPARTMENT
�rrvo 000588 CERT�FICATE>Q�F DEATH
mr.�.�u - -----s`�......__-.�._:�. --
This photoco�y is a lrue copy of the record
on file with ;`�e Namiltcn County Health Dept.
: DATE' f UL 1 � �0�� ._
Fpcesi 10_ If peaT Oo[v�eC L A Ibsplal'. l0a tl DeaT OmmeC $arext�e�e OTer il�a� q Hosqtal
.❑ Nospce Facity ❑ DemOnps Hame ❑ Nursvp HanNLmpbfm Carv Favity
❑ Yes � No ❑ Unknwm ❑ ImeUen 0 Emcgexypepaitmerv Wtpa4em � DeaEOnMnzl ����q.) DAUGHTER'S HOME
11. Faz3y Name Qf Nd Nstabor�' Wc SPeet eq NuMe�j � "
18333 DESHANE AVENUE �"� � "� - �
12. CM Or Towet SUta. Mq LC CoCe r. ,. �.i_. . �_ . � 1]. Canh Of DeM ta. Mama� suw ni r [r 1]�ar
il )i.o • � � :'.
425 WEST GLENDALE STREET
19. Dece�mt� EC�ce:m YJ De�
SOME COLLEGE CREDIT, BUT NOT A
DFGREE NOTH
I� ana O am,eiia, O owwwn � Fmm,emen
❑ Rxwm From Suu
❑ Yes � No
f77►.G
DALE
IN
❑ ManeE Q NameO. BulSepxxfe0 ❑ Prortea
� `MCOweO ❑ Nevet MameE � UnFnwn
� Yes ❑ No
FH83005677
ICHARD DEAN HICKROD , BY ELECTRONIC SIGNATURE IFD07012153
Cavse Ot Dwt� (Sea Inswcfima AM ERamples� Apprpavnata
28. Pan L Erna The Cnan 0� Evems - Diseases, 4yuries, Or Complicatians - Ttw� Duetty Caused TTa Dea.h. Do No� Emer Termnal Evems 4werval-. Onsei
SuCi As CarGac Mesl Respvatay Mest, OrVerYUinRar Fibn0alqn WnM�n Stwwnp Ttre Hidogy. Do NM PObevia;e. EMer ONy One Causa On To Deatn
A L�. ACE AOEM1VUI Leies H Necessary.
ImmeGata Ca�se (iinal Diseasa Or CatlM1ron ResWling N DeaN) A FAILURE TO TMRNE d VvEEKS
mion..
Seque�Yiahy List ConO�tians, tl My. LeaCVg To The Ca�ae L'ateO On B. AIZHEIMERS DISEASE 10 YEARS
Lna A EeGn T1n UMerl��np Cause (Oiseasa Or Irqiay TTa1 Wtiatea `�P °�
TM EveNS Resutlrtg In peaN) Last �. �{ypERTEN510N 20 YEARS
. o.m�ar,.ncw�o�.�uo0 �
o.
I O Yu ❑ PraOaDy � No O VN�+oim
___. __--___....----•-°-----_._..__.
as o
J0. Ktn n�topsy Fwvq Avatlada To Comple:e Tlx Cause 01 DeaAi � Yes 0 No
!2. 11 Fema�e. 3J. Mamet Oi DeaT'
❑�.A•w�.w,r.av.., ❑ A•a..ur.�.ao..., ❑ wa..wM1S.n.s.+vwM.�mr.ao-m � r�awa� O nommv ❑ nrdaem ❑ Pmmroimesueawn
(lrrna•weun.o.naun�.�ws.r.o..v. I�Ius..��n�aaw.�in.n�r.. Pl5iitl0ePlCOJCNdBeOetamircE
SIGNATURE
cm-ier
❑ Yes ❑ No
No. 380. Lp CoOe
nui n �a�.no:drl
❑ Ham Q:mr
a5 DabCci.SeG
o�ro%izo� i
vDay/Yeai:
2011
ESTATE: TTe $oaal Seamty e iz �eing raPxsteO Cy tNS state egency n atler to pusue respansAMy. Discbsure is whmtary aN tMea wA Ee ro penaly fa re:�sal.