Death Certificate - Vessels, Murriel_5/10/2013 i TIATI TE • ; . : , 897648
? k CERTIFICATE OF DEATH
•A 1:..
Local No 000047 EDR No 000000311480 state No 011383
1.Deadest,Lee cams(Fen.lAn Lan) 1a n en Nam(d female) 2.Sex 3.Tme Of Death 4.Data Of Dena(MordVDMIY,a)
MURRIEL M VESSELS EPLEY FEMALE 11:55 AM 03/06/2013
❑Hospice Fealty 0 Demdnt,ram ❑Nutt 1lonuesemmn Cm Fem:y
0 Ye 0 No O utwrwwn 0 w=en O Eeneveay Dormers O tehet O Dead m Anaal D Ors(Spsly) -
11.Feely None(a Na taNrlan,Gist Street and Neater)
632 EAST EISENHOWER LANE
12.City Or Ten&Sae.AM to Cods 4 13.Canty Of Dean 14. Mani Slaw Nitre Of Death
0 Marled 0 Ian.DASaoated 0 Don
HAUBSTADT,IN,47639 GIBSON 0 Widowed 0 Never Marred 0 Unknown
15.StisWq Space,Nam 15e.(e LWl)GI,e Maiden Lan Nave It Decodes Usual OagatM 17.Kind Of&vtealMenry
•
SHIPPING AND LABELING TJ MAXX
to Residence-Sate 18e.Carry M.Oty Or Town
INDIANA GIBSON HAUBSTADT •
18c. SteetAM Nmber 18d.Apt.No. 18e. de Dp Co 1e.rum Cry Lhwa7
632 EISENHOWER LANE 47639 0 Yes 0 No
19.Decedents&neon M.-Donn Of Finete pion 21. Deo:dens Ram
9TH-12TH GRADE;NO DIPLOMA NOT HISPANIC White •
22_Fees Na,.(Rest.Made,Last) 23.Lions Nate(GM,Min Last 23a.Mtn n Staten Las Nam
LARRY EPLEY - RACHEL NELL ROBINSON
24.1ntrnents Na,. 24a.Relationship To Decent 240.NMtg Address(Sad AM Number,ay.State.$Code)
MARLIN STILLEY COMPANION 632 EAST EISENHOWER LANE,HAUBSTADT, IN 47639
.row Of mammon
25a Menod Of Dbpmym 256 Flee Of Dt.mommn(Nam Of anen.Cmmery.Oyer Plce) 2$c Lamlm-Cry.Town.AM Sate
0 Bath 0 pentem 0 Datum 0 Ermmme t
0 Remora From Sate
Dots(SPCA- ALEXANDER MEMORIAL PARK EVANSVILLE,IN
2a We Cams Cae:ed7 27.Nam AM Cone Address Of Firmed Fealty 27e.F ne n Henn Ltarea Pa
_ D rat D ALEXANDER FUNERAL HOME,NORTH CHAPEL,4200 STRINGTOWN ROAD, EVANSVILLE,
IN 47710 -- - - . - ----- - -._ FR19900016 _ _
276 Sgneate Or IFanral Sacvice Lka.M: Lla se Matte In
seek aaek 2
-ANDREW D.ALEXANDER,BY ELECTRONIC SIGNATURE I 21c.21c.F029400001
Cane Of Data(See unmcaaa And Examples) Appradnate
28.Pmt I.ENS The Chain Of Event -Diseases,tjnk Or CanpecS•aa-That Directly Cased The Death.Do Not ENS Tent Events Intern Omat
Sod)As Cardiac Artest.Rmpkatay Artest.Or Vemfatar Minn Wnoul Shdwtg The Etidogy.Do Not AaaeMete.ENS Only One Cause On To Death
A Une. Add Aden Lines If Necessary.
Immediate Cause(Fed Disease Or Cadtiaa Resl&uty h Dean) A. METASTATIC ADENOCARCINOMA OF THE BREAST 4 YEARS
onto Yl ospem
Sequester List CatLYaa. If Any,Leading To The Cause Listed On et
Line A. Enter The Undo g Came Obeaae Or tidy That ktisatd ono.An Cowen Ors
The Event Rent In DaM')Last C.
Ow w lo.As 4 Cave m
D.
Pat IL Etter Ors &A Not Reset N The Umalsirg Cam Ght In Pen l 28.Was M nosy Pecan 0 Yea 0 No •
_ . . 30.Were ANopsy FMtg AvMane To Compete TM Came Of Death?_ 0 Yea 0 No
31.m Tenon Use Cottle To Des,? 32_If Fe,t -33.Mars Of Oen
❑Yes ❑Probably®hip ❑Ulnown 0 w°we-`°"v- 0 nrunrao... 0 Not w,w.tes.w.en.rsrao,,.ao.+ 0 Names 0 Ham 0 Accident 0 Poet mvevgea ,
D rcr•.4 u•••••a ow.t.t,..eon p.m D tw r winos*n..r r.r D Sulfide 0 Could Not Be Deoam,ed
34.Date Of May(Mconme ear) 35.Tam Of tiny 3t) Rase Of hey(EG..Decedents Flonla.Cmsoaden See.Rmaaat Wooded Area) 37.spry Al Wttlt/
DYes 0 N
38.Len Of Injury-Son 38a City Or Town ISO Sea A Nance-, 38e.Apt Na 38d.Zip Cam
39.Describe How buoy Orated - " �,- 't�.- ��'Eti�.,Da..pal
-'A1
41.Stone.Of Paso,CSayty Case Of Deans - 42.Center(CInsA Only One)
ANTHONY W STEPHENS,BY ELECTRONIC SIGNATURE - . I 0 c. g 0� 0 HQ'"O�
43. Nana Address And Zp Cow Of Penal Catfb Cede Of On - - .. 44.ukase Mats 45.Dae need
ANTHONY W STEPHENS ,3699 EPWORTH ROAD, NEWBURGH,IN 47630 - 01040406A 03/07/2013•46.Anne'Fteenl SaMOe Prmtlen 4T.•Alm
48.Senors of Leal Itt OtI - - 149. For Wear Only .Dan Feed(MmoJayneat
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE . - MAR 08 2013
AMENDMENT TO CERTIFICATE U1;DFATN(ENTRY OR ORIGINAL)
ate Deb- ) 9-3t)- jot - oQo• tills- Dc7it
J5 85 ATTENTION ESTATE:The Sodal Security C e being molested by this state even.,in order to Wane rmponsWy. Disclosure t nary aft there tell be no penalty for noaat.