Death Certificate - Walker, Geraldine_5/15/2013 "'• INDIANA STAIEUEPAKIMENIOFHtALIH bJbJ4t5
- CERTIFICATE OF DEATH
`ee Local No 000068
EDR No 000000318796 State No 018594
1.Decedent's Legal Nave(Fist Meek,last) tat.Madan Name(H female) 2 Sex 3. Tme Of Dean 4. On Of Deal IAbrcwaYh'ezrl
GERALDINE WALKER ARNOLD FEMALE 09:30 AM 04/14/2013
10.h Dear.Oconee m A Hmata: 'Ca.tf Deem Omured Some-ere Omer That A lmpul
0 Nosdce Fealty 0 Desxnrs Hare 0 &xitnp PaneAang-r•4rn Cart Farley
0 Yes 0 No 0 Unwdwn 0 evened 0 Ernergencq Department Oupater4 0 Dead on Ararat 0 omer(spec,y)
11. Fanny Name (h Na Institution.Gilt Steel and Number)
2764 EAST 100 ROAD NORTH 13 Canty Of Deem u.Mara ninon A<canemDean
12.City a own,Sue,And zp Cone
0 Married❑Mameo,But seoaazd ❑Divorcee
PRINCETON, IN.47640 GIBSON D Wry 0 Never Mimeo 0 UntOwn
15 Sta'.+enp Spouse's Name . 15a.(h W ee)Give Maien Last Name 16. Dreoe is Uwe/Oct pmn O. Kin Of Busnainaustre
PROMOTIONAL FOOD
DAVID WALKER • SALES RETAIL MARKETING
1e. Pzsiderpe-State
1Ba.Cwnty lab.City Or Town
INDIANA GIBSON PRINCETON
18c.Street bid Number 18c.Apt No. 18e" Zip Cone 16..Insole Cay Lent?
2764 EAST 100 ROAD NORTH
47670 ❑Yes 0 No
•19.Decedents EOucatOn 20. Deccont Of Hepatic Oran 21. Decedents Race
HIGH SCHOOL GRADUATE OR GED NOT HISPANIC White
COMPLETED 23.Mans Name(ant Made.Last) 23a.Anvers Main last Nat
lL Panels Name lFrst I1:pe.Las:)
WILLIAM ARNOLD ANTOINETTE ARNOLD LOCONTO
24.Inlonnairs Name 24a.RelsanNC To Desaen: 24o.Wing Auaes(Steel And Ntanoa.City.Stale,Zee Cone)
DAVID WALKER HUSBAND 2764 EAST 100 ROAD NORTH,PRINCETON, IN 47670
25.Place Of Dspositon
25a Mend Of Disoo of 250-Race 01 Disown(Name Of Canary.Cnemaby,Over Race) 25c.Loatm-Cay.Ton,And Slate
0 tetanal 0 Crematon 0 Donato,0 Ermnpnci
0 Removal From Sue
0 Other(Speofyj EVANSVILLE CREMATORY EVANSVILLE, IN
26.Was Canner Carcaaed? 27. Name And Cordate Aoaress Of Funeral Fatty 27a. Funeral tote License Nmcr.
0 Yes 0 No DOYLE FUNERAL HOME, 520 S MAIN ST,PRINCETON, IN 47670 - FH10400010
27e. Sgnatse Of Irian Fi eral Service Licensee: 27c.Larne Number(Of 1--censee)
BARRETT W.DOYLE.BY ELECTRONIC SIGNATURE FD29500009
Cause Of Death (See Insbtetions And Examples) Aoonscimate
26.Part I.Enter The Chan Of Errs -Useases.Injuries,Or Camp@ alias-That Ovacly Caused The Death-Do Not Enter Terminal Events Ime al:Onset
Sch As Carnac Melt Resgr&ay Arrest Or Ver'etpar Fionsatat WSmaa Seeming The Etioogy.Do Na Arne/late.Erne Only One Cause On To Death
A Line. And A06dnal liras If Necessary.
Immediate Cause(Find Denare Or Condon Restating In Death) A. RESPIRATORY FAILURE FEW DAYS
0.w.10,4AG-v-a;
Sequentially List Candl ens. tf My,Leading To The Cause Listen On B. AAIYOTROPHIC LATERAL SCLEROSIS YE
w'lo... a
YEAR
tine the A. Enter The Unsoelya d Cause(Dsease Or Injury That Initiated
ev
The Evems Raag N Dean)Last C.
Ow•W.u.Gnaw d'
0.
Pat I.EMS Other aerstlie DedT But Not Restsng In The lndrMg Case Gran In PM I 29.Was An AtMOsy Penance O Yea 0 No
30.Were Autopsy Faring Andre To Corse The Cane Of Death? 0 Yes 0 He
HYPOTHYROIDISM,DEPRESSION - -- 33. Mama Of Dealt.
31. Den TO Pt Use Can To Dean? 32.'Female:
®..r„e-.v...A.w"4' D...,y-RTr"arm.. 0ew',sew*I.A.v-a wow n b.i:an.or" ®wturs0 imnae ❑Amdent O Panting lnyemgaeon
❑Yes ❑Pnmabry®end ❑lMimdmn 0..ee•.e-s-6t°w...d,.T.n n-e.,.or ❑;.....'r°..-...."n,.....W ❑Si iane 0 case Na Be Determined
34.Dee Of Injury(* itV ayl'Y ) 35.Tess Of injury 36. Raz Of Iteay(E.G..Drs Marne.CayszucIDn See.Restarts t Wowed Area) 37. Iryuy At Wen?
O Yes 0 N
38.Locator'Of Irytry-State 38a.Cay Or Town 38c. S..e6 Nanbr 38c. Act No. 38a. Zrp Coale
39. Drape lit.(jury CmvneO . st.n..m.eT 0'n)ar).S� r 0a-a- .l
41.Set ra Of Person Certyrg Cane Of Dear 42.Career(Ceed Only One)
RAMESHBHAI P PATEL,BY ELECTRONIC SIGNATURE - '0 cC°ll'rc'"''Pin 0 Comic O Heat.Me
43.Nane.Amu ere Zoe Cox Of Person Cell/re Cane CR Dears: 4.i:re5.Nrncr 45. Dale Cetec
RAMESHBHAI P PATEL ,685 VAIL ST., PRINCETON, IN 47670 01040266A 04/16/2013
O. •Aar:
46.Adatandt Funeral Senesce PntsMde:
48.Signature of Lou:Heir.Oftwt 49. For Registrar Only -Dale Fib (McnNJaylYeaj
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE - . APR 17 2013
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
a6-1 -03- t00-000 ' 0.5q-oaf
5'5 17.-",c2‘ 001- 0314 -cat')
State)yam 53325 ATTENTION ESTATE:The Social Seamy a is Deng requested by this state agency in nrden to pursue responsibility- Drsaosure is voluntary and there war be no penalty for refisaL
.1r .. IVRA-20
':CC' ' ': (7/05)
r-VOID IF ALTERED OR ERASED 'NOTVALID UNLESS CERTIFIED RY,HEALTH DEPARTMENT:
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