Death Certificate_Miley AeR-18-2013 10:41A FROM:DON REEVES 3858641 70:3867805 P.2
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Ai;E% INDIANA STATE DEPARTMENT OF HEALTH 860192
A CERTIFICATE OF DEATH
Local No 001258 EDR No 000000266469 State No 029882
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INDIANA GIBSON OAKLAND CITY
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06/20/2012 14:40 FARM O Y. ®No
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INDIANA - /FORT BRANCH BENDERS FARM LANE .�n �0�a'� �4y 47648-0000
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ANNIE E.GROVES,BY ELECTRONIC SIGNATURE p Cs»yna Plrrrnn 5 caw 0 N.aorar
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ANNIE E.GROVES ,201 S.MORTON AVENUE.EVANSVILLE,IN 47713 NONE 06282012
.i Ap2f Fuser.Berne Rymer, 47 'Ma.
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RAYMOND W.NICHOLSON,JR.,VIA ELECTRONIC SIGNATURE JUL 09 2012
AMENDMENT TO CERTIFICATE OPOEAM(ENTRY OR ORIGINAL) 1
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