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Death Certificate - Wright, Martha Jane_6/30/2011535474 CERTIFICATE OF DEATH �ocai No 000115 EDR No OOOOOOZO�J4.3� 1 81 � oan � �v�s 07/20/7929 . PRINCETON, IN 9- E�v in U.S. NmlE FoeUS7 10.1f DpaN OccvrteE In A Hc¢qW: IOa. H Dea'.h O[airte0 SmiexTere OTC Tt:an A Ho5qU1 ❑ Hmuce Fao3b � DeceOenfs Home ❑ Nursin9 ManeAC^Pfam Care FaoTy ❑ res � No ❑ u�knwm ❑ NO�ent O Ene9mry Oeparoneirt OubaO<m p owa oo a�;.�i p oma tswoNl ❑ r�ameo O Mar�ea. an smar.ea ❑ aw�cea I � vrowea ❑ rx.er neamea ❑ taii,wm EAST 150 SOUTH � �«amrs ea�cazo zo. o�eoan o' n�o�+K o�rem i SCHOOL GRADUATE OR GED � ,� � e�.w p c�ema:», p oowao� O emao�n,«n ❑ Rertpal From State ❑ om� �so«dyk ST JOSEPH CEMETERY PRINCETON. IN 2b. waz coronv emtsxea'! n. wme n„o c«nd� nmrecs rn Funcal FaaYn zlz. Fwc ❑ ves � r+o COLVIN FUNERAL HOME INC, 425 N MAIN ST., PRINCETON, IN 47670 FH8300 ZIC. SqnaarteOlNOanaFU�tl315lMClL'KMStt: 2ic LicmxMmECIOfUCatseek NARK R. WALTER , BY ELECTRONIC SIGNATURE FD01013010 Cause Of Death (Sea Inetructions AnE Examples) 2B. Part I. Entn Tl�e Cnain O( Events - Diseazes. Injunes• or ComplicaLOre - Ttiat WeNy Caused T1�e Deatli. Do Not Enter Tmninal Evens $url� As CerEiec Arzest, Rnpiretory Mest Or VenMwlar FiCnllaom WiNOUt Snowing Tl�e EUdogy. Do No� AD�raNata. Enter ONy One Cause On A Line. AOtl AQtlNnal lines Ii Necessary. ImmeCiate Cause (Final Diseaze Or Contlltion ResulUng In Deatt�) A. LUNG CANCER WITM BONE METASTASES e�n...�o� Sepumtiary List ConCiUOns. H My, Leatling To The Cause Lis:ea On B� LineA. En•sTlieUnEetyin9��elaseaseOrinjuryThatku;ia;M °��'o•••�� TM EvenLt HetW',vy In Deatn) le5l C. o�a...,e..v� D. ❑ Yes � Na nppradma;e In:wal: U¢et To DeaN vanv.mxrtmeaanfxxni.omams�on:nov:nacoxa.��_Rnwtesm��y��ir.�w.:emb., ����^���,�.a��� .••�^,�^�+�w�. .....��... Ves No 30. vlere /w.opsY FinCVg nvaeade ioCampei Tne Cwse 01 Dea'.n? ❑ Yes � No 31.ObTCermUSeCmbOU'aioDeat�? 3i.lf�e.:ale: �. �Ma�a�+: � Ya ❑ ROpipIY � No � UnYnPm ❑ re�T.w+wenvmrw � Aw+u:...ao�n � r.a�.pv�aanm��we.��zo.n7x � NaLral Q Ha:icOe ❑ ACtiOlM ❑ Pen6n9�.ve5993m ❑wnv�KmAw+ao.n*=�r+�e.e.o..n ❑uwv.eenw�wav.ir.c..r� ❑S�nck<OCabNnBeDetemYneC 3a. WbOfNN�Y(MmYJDaYIYpr) 35. TmeOtinNry 38. PUCeOfNMYIEG..�ecedenfsF-nne.Con57uction5i:e,RCVwmlWaoOeERma) 3). L-N�YRtWOek? ❑ Yes ❑ No ST VIA 'Cnerk anN onel cnvvtlao n coron« JUN 29 2011 �a.�no�at I-I HeaT M..icet 3995 q7TENTION ESTATE: The Sodal Secunry c is Derg reQUrs:eC Dy Uvs stete aqercy in ortler to pursue re3ponvo3ry. Gsdos�re is wluntary an0 Nera xiA Ee no pmalry for re:vsal. NRA-20 (7105) 1 1 . 1: 1 1: ._ 1 � 1 . 1 � . 1: . e 1. 1��