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Death Certificate - Ziliak, David C_6/11/2007' •-+ ATT�EHpuTe70r,Ne aESTATETIfa SWaI SaNtic/� b :.; - _" . . . _ ' - ' 3.y`•,-'_�0�-�-.we,161e1+torYresP�+siDi�YDixbwre's ' .. � i we�n�y,anomerc�xr.oxna.ryrorremsai. INDIANA STATE DEPARTMENT OF HEALTH �`�� j H�..:� OL?.7... CERTIFICATE OF DEATH ,;; Lccal I�o.. � . _� _ca-- iME 0.ECOROS IN THIS SERIES ME CONF�CErv i IT1 FER IC t631-t q0 o�cc.aro....uc F�.�+�.�a � v 410= ' > �n= David C Ziliak ij�'' �. * SOCLV. SECURIiY NL'.u2ER •w. IGE. Lm Qrt'C�f S V'NCEe l YEIp (�_ _2' .�ii Lt M J u�a. �-- C+v+ h y� � � C:JMIlSi:CA'.EC W T22 � �U�. �iEM�� US.�o�E:i�P�Ei• rC.vi:.t' ❑ ypp�y /lJ� 5 ... C; No N/A co.c.- I Y�1'J � -: 'I� fK4�;vF4�E (�NIr1/VMpb<v�funur..+) +�C1r � �. v � River Oaks (�] ��' Z { ./:�G�::1SV�iUS I:. SP'Ai�MGS"+_WSE ^�i.0 V (:T�� /�/�eY.Pe.-ain�frl • C� _�' Ma=ried Dolezes NeSer t Statz No ........................... C4 a�_iiv[fFCG'� sle 3:31 P`d f O+:E Of P.A:v (r�. G�. Y'1 � uaust 15.19d5 L�:COfCG�� wRG�.lI./ >ril 4, 2007 :�mu�clf+r a<u�r v to� r cv^^�l Dayliqht, InCiana p=FA � Wa+V +rs QCC f5a•>yl � Princetor. CE:EOEV'su:�:xOC�lo�i:G: fCwn:.flU.o+ m.a,:�:,�.�v�r.o.,s-e o-��.+:s..,.w: �C- �.. cc:_c�cc.cv..� . cc�..-v > <:-..:cw..o�.iw:io� l^� u -��, ir.diana G_bson cort 3raac'r. �n=' ��.n.:tt_ �n.wsr_cci;vu�:s ..crrzt.ca v:.:�ce:,crr.ctras�,�.xcaici.i �- _so ❑ v<s :.•.�: c<o.:�" 3 n_ O Y•• �>n. a-c. cw. J[`• n �1] C�:�'�GU+ rr._u«.umna:i a:l v�� USh � C7 � ^ 57648' � no ❑ vm �^ r. If f.::�EiS�VIF Ii�=.M}T.'vq 19 4]:- ~� CL2�115 Z111dK EL[:f ai_ G�son �c c� cum I7227 S,S2� r '.! MCE-A:.erc.v�Na� t:.CECE�]E�.eF?:C�:ICA E'xi..':.`a e!. fy'!�Yiayynp.etT. �t`:; lS"-`A1 � ...n ��e:: nP- Tr'!: i te 12 - .�;� .Ya V.ftiP�41:^SNAV� (T�pePV:: �:c I.L.�L�4':a^::41.'.)'('1eMa.�l':vM�e�F.ilu��ty.V'vr�Le,UnIS.RJY!,:n4+b1 :�C FeIJ'.'�"ly::p �� Dolores Ziliak 7227 S C25 E Fort Hranch, IN C7618- I Wife �� /c:NCCOiCiSa'Y:1CY ❑�.�� e.C�.Ea.�.'.a'10EGiG`..:C_:i4^.nf::��'�/.`�'eFr.U'v�).v )!:I�J:I.v-Cry.riy..5�e e ` I '. �,.d.-�� <= �:,.,. ❑.e,..,� ❑-..._...,,,, r,oz�i �, �oo; � � I ��="Y"8` ❑R �='^"''� c S� Bernards Ce�etery Fo=t 6ra�ch, Indiana „^_ I"+ e�'�':_V:P�..vuE ,./Y_�GTull_E.`CE W ' .. .:'_ :nFEY_�i-�:]::n:.\v.' .�. �. . ..� S. NO � Y.f �;;; Ro3ert S S�od hi11� ;�; ED0102:378 _ I ` �. X'a ��ECCµy�tLCfTE_i_R� / � 4:ICEViE'4V^J.il �S :UYE.t�CFii�.J:,�LIC`.1�.4A1EE?�:FlyYEpT�1�F r.. - i i=. >�• . .: � � I-a,�:.a� 5'-?ySe"'?L.e'a_h"c.:..�. .-3?3:'?27:i ? � � "�� n/ �!- /�" 3J4 ::est Lowst 5:. - cC ." �%�L1.7� ✓r // �//i FD01024378 sorc ecar.ch znCiaa <v5: ^_ - �? a r:,r.i �ia«r�Y......a.K v�,�....,.se.r.a�...,•_-.....�� _,,.,�,��...-�..r...,......,.n..,.��, . , - � •'..a.��vt.- _~�.� .�..o�..:�ct � �y - r��io !�1SYOm - rn�v�iFo�� r„ -0 ravtr:r-::a,seu�.�: � n- n� :.,.�owYn ° c�:e� se �M::e^LE:.cec9: o �� ,.x�,R:.,«�� i �..-..: �� ' � np � . .. e�r:o .- e cec�,. _� � - ..�,n«��< - �: � G � .a.�y: - O :�w �:re::icc,::.ca " rc ^ri ' (', ? � O v' . /j � � Ofl i..n C'.n,yi•�..u.a�n:!.[�:.CUC::•.5':.`i�'u.:.n].a.:[.rt+:�:�aly.4�rJ}il:�..l'r' / �. COT O (,6V � o ^ GIBSON COUNT� -0 > � s. c�+"r.�c� '::.:iKC]ES: I.v.� .�s} .-au.[o. =.:�c�_ r c: -.: c'.=. ..aP: -�..�,�. ,82i�1�C;w�rr rv..�.....� No v.epta:c=, �c.x.c- ..1nJglE oo4'f :� CO::J'lEi1G::0: L:USE o�c�:v_, r..,>,.,. No � � y 1'�._.�..�r Lh c�o.rFr'a,v.+vrc:+� �.� �u.�vmr n. ...�..v.�+o.as+-iamez:+...;n..-�NT.ve�:a.,�er_�:%el+lnrr_. � -^ �•••� �.�E�:1':'rtCEa GCipm4..a.n.v.natna.rV:m.mc�q..:qM1r_rriai_.aM1.rq..lJN>am.a-c_.nc_.�n.Ynu:iaC I >� j�C�PCM1CV r.ry. �.- _ . .aN><.a.v]:..e!_�`�uuyp�[I +rv�na5aiea rU -..r.......v=.n�.r.�eovne:w. ' �. .,�,,.: u.�vcc¢��ce.:s.c �w:e:+F�_:.w -..i..� c .c�� G ��>l01�02�5 �f��+l c�i-�n; � o ., :v.,�.•.o.�a_ ,��o.:,,,�.a•,�-E��.�:�o- ��.:,,;�:",:�, �,�..P,,: �•'t\ � Dr. :nresi� P Palc_ hi.D. . -- �y�-Ua � i05 N. 2r.d i,ve. �riaceto.^., _TN 47670 � .�' �� r .h.:::-.c�wcer:s..��..:v.' J^ / p . I11 (n = r: �i�-G-'� ��.. ��•�i�,j / �,�t./ !' _:. "' �_. -,�.��c " I ....:.Y_ �, c_ .,. . ..., c `�: . .. ' . . oo�.."" , wc� .: �no.. , > _ •fax.w. r:�n u:..,�i �rv.,�,.:i j\ o- u �_,.,� ❑ N� � �t'1:�M U 4c�i^/, -.11 �a a.l��. [ �."� ❑:�.a.. ❑ ,, _ ��r:r�,�� rs,�, � '• ❑ -�, «�� Li i. c� I:JI.KC'v'.u.: IW-'�`.��. �'a' r .:.4J'CA'.c:...C'��.:^I�E.:s � e.r.e. Rm.>�.re.�r.M%1""'.aw'ten.*: �, F.�_1i 4� zoo� y "ii0 � SOH06-OOa Stat? Fortn 10170 (RS17-99) .� �� W ��.$) fl�.': !-b(�.' '. .........__._.__._.._.. ._......,..._ _._._._.. ?;°J•ii(lili IF'AItEREO��11 EitA.4E0 =''NOT�.VALI� UNLFSS CEN7IFIED BY:HEALTH-0EPAflTI'dEM'