Death Certificate - Fisher, Marlene_3/18/2013 INDIANA STATE DEPARTMENT OF HEALTH O 0 0 .1_e - CERTIFICATE OF DEATH
000000311364 State No 012517
�':dentsLr Local No 000049 EDR No 4. Oxa05De< :(Mnn_maynear)
�e!�` la.Maiden Name(If female) 2.Sex 3. Time Death
1.Decedent's Legal Name(Fret.Middle,La50 03/05/2013
IMARLENE SUE FISHER
CUNNINGHAM I FEMALE 03:38 AM
61 Mors Days Hours Lass 05/23/1951 PRINCETON, IN
doer. If Dean o�,�m Son...Ma Other Thad A rwzoa�
9.EwmU.S.Armed Faces? 10.11 neat.occvrecNAHmI%al: 0 H05*e Racily ❑DeCedenfa Home ❑Nurstrq HomekortW'Care Fealty
0 Yes 0 No 0 Unknown I 0 Inpatem®Emergency Dewrnent OuNtent 0 Dean on Anal 0 Ozer(SDeofY)
11. Faulty Name(It Not Inntmcd.Grve Sweet ant Number)
GIBSON GENERAL HOSPITAL
12.Coy Or Tor.State,AZC Zip Cale 13 County Cf Death 14,Mar.tal Stetm Al rrne Of Death
0 warned❑Married.But Separated 0 Diwmed
GIBSON 0 wwaaed 0 Never Maned O easen
PRINCETON, IN,47670 16.DecederKSUsual Ocaasasn 17' K`dOfBusizessfl'oduzy
15.Su lw'g Spouse's Name 1St.(If W'e)3iW Maiden Last Name
TREASURER EDUCATION
MARVIN FISHER 15a.County 180.City Or Twvn
19.Reskerce•S•xe
INDIANA GIBSON PRINCETON
181 Apt No. 15e.LD Core 1S.Lade City Less?
disc.Street Am Number 0 Yes 0 No
1802 WEST BRUMFIELD AVENUE 47670
19.Decedents Education
20. Decedent Of Hispanic Onga 21. Decedents Race
HIGH SCHOOL GRADUATE OR GED NOT HISPANIC White
COMPLETED z3.MOCxrsWhite lMiaale.Last) z3a.Mdaersrux,Lazr:an+e Name
V.Faders Name(rust Made.Last)
MARVIN CUNNINGHAM
CAROL JEAN JONES BROWN
24.Informants Name 24a.RdatmsNp To Decedent 24b.hsaa^9 Ade'ess(Seise And Number.City,Stan,LO Code)
MARVIN FISHER HUSBAND 1802 WEST BRUMFIELD AVENUE, PRINCETON, IN 47670
25.Raw Of Dsooston
25a.Metal Of Ciseccn 25b.Race Of oislomson(Name Of Cerneer5t Crema:ay.Other Race) 25'.Locasan-City,Twm,And State
0 Banal 0 Cremate: 0 Donation 0 Ensmbrem
❑Removal FromSnn HAZLETON, IN
O Ozer(Speedy): SHILOHCEMETERY - 2TaFa,ea1lieneLxeraeNUmber-
25.Was Coroner Conlxuo? 27.Name And Compete Address Of Funeral Facility
0 Yes 0 No COLVIN FUNERAL HOME INC,425 N MAIN ST., PRINCETON, IN 47670 FH83005671
27c.License Number(Of Liceraee5
A KR. Of LTWRneralSeEL ELECTRONIC IFD01013010
MARK R.WALTER, BY ELECTRONIC SIGNATURE Cause Of Death (See Instructions And Examples) Ap✓wimate
Caused The Death.Do Not Enter Terminal Events Interval Oft
23.her;I.Enter The(Ter n d Etory r Diseases.Injuries. ib llampGWm-That err mb Etiology.Do Not Abbreviate.Enter ONy One Cause On To Death
Such As Cardiac Ands:Respiratory Arrest.Or Vermicular FiO.^.gatlm Without Soo-tvin9 oW'�
A Line. Add Addrdnal Unes if Necessary. IMMED
Immediate Cause(Final a
a/Disease Or Cdl'van Resulting In Death) A. CARDIAC ARRHYTHMIA D.o ra a e..Ca..e 04
MINUTES
B. ACUTE MYOCARDIAL INFARCT o.star. aw..w.a on
Lne A.Ent The U deenWS Cause(Disease Or IN7 That Mutated
The Evens Resulting In Death)Last C. ow wick GA C.e°.o OR
D.
Pan II.Enter Other agn,fCa t Cormaos Conttuvno to Death But Not Resultng In The Underlying Cause Ginn In Pat I 29.Was An Autopsy Performed? 0 Yes 0 No
30.Were Autopsy Riding Available To Complete The Cause Of Death? 0 Yes 0 No
NA 33. Mamer 01 Death:
31.Dm Tpoacoo'tiy 0 No To Dean? 32. '' '' :
w A.w+w�.temt�. T>•+'au-wpin vnv+a 6+n.a++wv.tm0.r.a:w. ®Hassel anneQ Homicide ❑PGO7n1l ❑PeMtg'Iml59GZ'a1
❑Yes ❑PmhabN❑No ®leeward
0 NO ne+s as=Thos..aanie I..,e.e.aat ®u."^"I rice we.t I.eta Vier 0 SWade 0 Calf Not Be Deed
34.Data Of 1niury(hkntYOay(Year) 35.Time CI Injury 36.Place Of Injury(E.G.,Decedents Horne.Cps:ow Sne,Res3var.Wooded Area) 37. L-{'ay Oa Wolf?
0 Yes 0 No
38.Locators Of Irfly-State 38a.City Or Town
36b. Sweet&Number 38c.A#.No. 380.DP Code
a0. If Tranapa[atkn Infiry,
39.Dese'se How Injury°Corned to. 5Tr nsc 0aI Irur e+..0°e-Ie'.�
42.Cereer(CO ed.Only One) ,
41.RRET Of W.DOYLE YLEir.BY L Of CT 0 Caddying Physician 0 Carne 0 Heat Oecer
BARRETT W.DOpCo .BY ELECTRONIC SIGNATURE E m License Minter 45.On Gutted
43.Name,ACpesf uk Lp Coded Person CM:Tybg Caused Death: -...
- 03/14/2013
BARRETT W. DOYLE ,520 SOUTH MAIN ST, PRINCETON, IN 47670 a7 •Axes:
46.AbiG w
anal Funeral Sim Fmvwen
a9. For Registrar Only •Da*:Jed(A earDaAYeaF
aS sgrasrexl�Ifealt'soPmri MAR 142013
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE
AMENDMENT CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
State Form 5i3v39�5_ATTENTION ESTATE:The Social Security°is being requested by this state agency in order to pursue responsibly.TDisclosure is volunney am there veil be no penny for refusal . - ,