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Death Certificate - Young, Addie L_6/21/1974� o � � ) �&d��� 4 _ ___" � � 4 � —_ - CY � ` y k . . � . " �. °_ ti . a -. ' ✓ .-- .� i . j'. f '�' - I�iDIANA STATE BOARD' _ - r. � _ " DI+L4�a d �9ta1 em a 4? _ _ �;, ' CERTIFICATE�OF` .1 _ PLACf'Oi DEAiH`= /�i '=i � S 4 UR ,.-_ .-i� .' �.� . . '...;COUNTY.�'. ._ , l �. ��._ ._�+.: 4 �- -_. ...'._ II __ � :�5 : �<u,��-. � Yd �FUl1NAME0 �.-.ot�v mpteloeinstiuqlio:%'ry�vicetrtete W x �-HOSMlALOL��/1��C:(.�� �� �� �- ':.WSTITUTIOy ' F s � 5 \� 3 NAME OF - `�nt) . ♦ � � L.,pLddle! � Z � � DECEASED: � r '��•/ Z' e: '�y," � fT�MmP N) ��j) I C.: . � f�` � 3 5 SEx -� � 6 C'O? OR RACE 7: EM�I�E,D�DN�E� 5 � , � �77�.�l.c- '- I �i.1t.w 5 �. � �� 10 AIOCCUPATION(Gi�zkmd (w+vh tOB. KIND OF BUSWES � LL1 � do �,to( k IJe.cvendmURll -. w�icr a ;' = _��L.�i�.c� �/�iL.is✓..� %LGwi..i Q }' �� 13. F iHER'S N/�ME J� -� � � - . . U� ' � � "' ' �.Ql " !�/�-�'-�1 � � ;. `� a1 s�. � 15. Wh5 DECE.18 EVER I $. ARNFD F E5� I 5'� J j T F.nteroalymeeauecper - �< < Z �. DISE/�SE OR CONDITION line tor (aI. @I. nod (e) -' ��9 Z�= DIREQLY IE�DING TO DEAiH• p�- z°9 O�- •Ti'v daa rwt .mm� �TECEDENT CAUSFS � p� y. (lr madr of dn!V. aw! .VmbW m�ditiom. iJ un.. a�•��o DUE TO ( (j �' e� ai leert Jail�r. ait4rnia. r- lo !4e ebo�r �auae fa) tlefln0 . z. ,� tfr. ll nroru' (dr dia- lie unLn(Yinp rauu ImL .. e` + �' nu, injw�, w rompiirn- � DUE TO � �<L � C �en a5lri rovuE dralA.' ��� OTHER SIGNI�IChNT CONDITIONS � ' a� .. �; C rdt�ane �onh�6�finq m tt.r dmt4 GW n t �y 9q .j _ � rr(atn7toli.d'ume�orwiditinnravainpdmfA. '- Z= S 3 � 79a. DATE Of 07ERn- 196. �M.�JOR FINDINGS OF ODERATION D e] �, v ': j ilONl � - . r = - � F_-s ,'Z p1e.�CC1�ENT- 1?c�fy) 416.DUC�OfI,�1JURY.(a � � Sl11CIDE . � - I Iwmr.fum.futay.nrcet aff� 3 L � ,�Vj HON,ICIDE • � � ,.: (. � ',j,' z 41d- TIfJi ,(�I nt6/ fDa51 (YriH fHourl 41c INJURY �OC y e� �, . U - pp .. _ ` WhJe n� Na � � Q 1VN2Y � : -. m. � `S'oh '. n 7 E` w .a .� . . � � : e . 0 ' y 44 .�TTENDING WIYSKIMI . 9 � � E a C µ C I ce`rc h�_� eamded tFe decus<� ( � 79 �tD'— �` ,�' .: U .19"�..andd�atdeathorcu?eda G lreuce�nnvai�da d on � V } [� E' _� 43��Ss'dh+�eolAttend�ns�ncu�orN�llh'OfSca- '. £ a r�, /��� ';: � Q � � 3 E • G c.�� + rE < s�, e' uei�i..cxEM� e��. o rE e<< � N.RE'I�O AUSwfy)I�.. r _ � �,,�� � , yf Y 3/; , ;�; , ` .� . sr�.z �DATE�REGD:BY+IOC/�L SIG ATURE. P TH�ORICEY•.� y - � � ' I+E�LLTH.OFfICER"t� 3- ' � .. _ ..� o � Z � i�� .i � :� � � ..:�� �i. � : i..: z= n�.Q�� 3: <.'.;�t� � .. .. . SBH &2Ma :... Tl' .,..�:' ..� /'�'%'� _ "'/•; I�, o T � � �� � � � �-•--- , .,„ ' . ��� � _ . � _ ^'C4 �.3M 3 � LTH r'�c � .. .-_ � - .' i-9M f'. . C+ �"'a r�' �.00L� �`o.: �.yp 'f +.� ��G^A' 2'� � ' � -s ��1.`try_�. _ ."Y.-s `1ee x�i__',' Death No_ %5 :.-�.a.,�.�: L tJCE �bjedya�yy�d: [IivtiNtioe �¢a_Wepoe�Tto2Wminvm)�' / F �= b.,, GOUNTY �� -� -.�,? 9 - jivpmtefrn4:uyRLILU.1 4 " ��-0 � � YYS�``/� � '�/� wit�a -•.'r- 3� •" pfmy,�tmbmJ � r �a'� y r '� �S! £ Y '�"b�iYY�.-^ _ '�:aM�Myi'�`� 1.�' .r .a.-. ,< S � �� I.�DATE (�1oot � (DaY) �'(Yr�t) � - : r-� ' z � � . ,�79�c `} CFATH— pp� v nAc� Gnns�� [t��j j� �ry�Iuomas�n,._ ^ /O ( Zi -,,,�T9 7� Itld�l%:O.{ Ram�ItSt�a , iateor qimur. � l4.GTRENOFWHAT�' �" . ;'�/._ '- � .qou��'+.. � _ P//77�7�fi � - � �� C �/ "/ /I�_ s I .� ' �i . _ t ' ;-. _ - -•�. •�� 41c (CITY, TOWN, OR TOWNSHIG) (C( •fG) •, . _ . q .. � 41C HOW DID INJURY OCCUR�. � n . - _ . 44b HEhLTH-0FFlCER _ : '_ = �� L� 1« n fY thet I�Imnhgated ea se d dee.h ol d�n� � •:.� _MYroc umei suKd ad on �bo.c < -.: 4 n OF CFMETERY O�� � .. �`� �•"� � l� '� IMERVAL B! '.-'- ONSEf nND " � •' 1 I' Yai Q. � ' - , st '; p