Death Certificate - Dixon, Mary Helen_10/22/2013 A -
.�a= • •' INDIANA STATE DEPARTMENT.'OF.HEALTH' / 1
1�ri 0 CERTIFICATE OF DEATH 2• CAr 4' .• '/
�� Local No 44 2' EDRINo 000000168566 DTP 1 7 7 1"G - State.No - O5 do is
I.Decedents Leo.)Arne,(FeSL!Melt Laid - la_Maiden Last Name(If emale' ;2.see r Tyne 01Dean 1 l Date Ol Deem wmefDavn«rl
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-MARY HELEN•OIxON 'RFLL • r ' FEMALE - ; 08:10 AM• • 12/08/2010
•
'91', .Mauves D.« I He« - _ • Ma.,l«.. .- 03/28/1919 I '!ALVIN,tILLINOIS
9.Ewer wU S.NIMd Fpcnl Io,II'Dean M A Moto-tat: 1 - . SO..If Death Occurred Somer./me Onet Than A Hornet l 11. '
_ h l pH«TCe Farity41 •❑Deedenti Marne 1N Nursing inellmnµmm Care Maim
-Oy«DRNO 0tnlrkw' , 0tnpamenl ❑ ErneCemy 0.gerenl PJbaoert LDead
MMVaI. ' 10-yr(SDeaM. ' r,
In.Eery Name.Dl Net Lontub s Gm Skeet and Wrrer1 LJ r C.,•IGFNTI1FCARE OF VINCFNNF,S' - - .7. -
12.C10TMLStak.MdZoCCM , -• Ii.Lauri Ol Dean , , le Mnw Surds Al Tune Of Dean
aQ vaned❑,' Mnned,adSeorated ❑D..cee
L'bewe[ N«n Mamma Lnenem.
.'e' .VINCENNES",INDIANA A7591 -• , KNOX -• ° ❑ (� ❑
- IS.Somme Spouses Name - . 15..nI LV Ie1CYee Maiden Last Nave - 161 Decedents Usual Occoolo.n • t) [nd 0l auiatei,bgrfh
'ALBERT.DIXON - _ SALES I :F t• '•BEAUTY SUPPLY
ae.Revdmee.sme ;f ii..ewN.n • . • IeO.Ch o-Tawn - _ .
INDIANA - KNOX - _ VINCENNES•: I r !
113c seeetfnd Number - .. ./. .Ida.MI YO ' I .iIyZo Code Ill LM1k.Dl.Lost
12025.16TH ST. - - e i • 1 47591 'CIYEi.OM
•'fa.Decedent.Educated 20 Decedent Of Moarvc dan. - „. 21 De>Aents Rue
-HIGH SCHOOL GRADUATE'OR GED '•= • t
COMPI•FTFD. • Not:Hispanic" . Waite
eZ.f.mva No era lres .LOe. sate • 123.Maser.Name(Fast.M.00e.Lasts i 23a.Mather.Maiden Last Name
WILLIAM HIBELL • MATTIE ELIZABETH BELL 1
WRIGHT.
2e.Moments Name. 20.ReulanWO To Deeadenl 20.Mama Mrtess(Street And Nmroer:Ctr.Stale.Lo Cartel
JERRY DIXON` SON - • 1712•OLD1WHEATLAND RD.:VINCENNES.INDIANA,47591
25.Rae Of U ootbtn 1
2255a.Memel Of Dnp«om '250.Race Of Onoouton(Name Cl Cemetery.Clem:m.ONu Ricci 25e Locnon•Db.Town.And SI M
rAural'❑Cunneen'❑Dmaaan•❑Emmement
Removal From State
1...Removal
Iooeay HAZLETON COMMUNITY CEMETERY HAZLETON INDIANA I
26.Vhs Conn CaRMee2 27.Nam Md Carmkte Wens Of Fenn Fo rn 27a.Funeral Hone Lucerne Amen.
❑Te3.®No COLVIN-FUNERAL HOME INC 425 N MAIN ST.,PRINCETON,INDIANA,47670 1 FH83005671
27e.S'tnatne Of Maria Fondue Sena Licern.e: 22c..Licm Nam*..lot ticen,nl. .
JOHN W WELLS;-BY ELECTRONIC SIGNATURE • I FD01009940
Cause Of Death (See instructions And Examples) •
29:Pan I.En:es Ina.Rain Of Events -Diseases.Iryutes,Or Compe ratan-Tnat Orectty Caused The Dear'Do Not Etter Terminal Everts \ boio.enale Meal. '
Such M Colo.ales Reapaby Anent.Or Vennapy Frlxd«o YaOM1 Show-;The ECtloty.Do Not Atseevule Enter OM One Cause On l)ei Add AODekW Lases ; ( Onset To Dean
V Aeasanr• ^_ ,s�y,L
L..edateCare(Fetal anise Of Denman Desoto;In 0.001 A- //_'.C�{L ,- /A('3VV" V y ) ' A �'
'SeLt0.. 1st b.If My,Lemberg To The Cause Lasted Di Me A.Enter y� es a cyuvz.ryr I .
]he Una.n(n9 came(Deem.o-Imey Tnal Misted The Everts Resting In
Death)Lest .C. I
Cu ternu•cm..e..m i
D.
J Pan II.Eno Other S.`.SOmrefeMryn•bc9Ymnn fOtbL AG NR/erodes In/Inc tm TM Cake Gum In Pan l < 29.11'm MtAUViy Performed? I
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- t'�l ��I 4,� Z A .�.,A+[ L&-L" L'L L_ce0_n a �LIA L�(`}Jt✓.IC Wert Autopsy Foams Avaladle To Complete The Cause Of Dean' Hy.. (�No
31.04 Toobaeu Use Cau44,T.Desalt'A' _ _ 32.If d•male:ta f•!L 33 Manner Of Dean: m
rr--��tt e+d0.•o' ukn- 2NoNlN nude ❑MOdE ❑Penonelmeimnsaoes
Odes ❑%e6atly Onto ^[IWlnown I I ..n.eu envm.)Os HAeu .te nine a.m..rww.M loon... • Suitede.. 0mmd.Ndree Oelemmed
N.DM Of ktin(MOnNDa.2Year1 35:Tune Oflnian "di 0.36:Race 00910061E G..Decedents Home.Cmicucoon Site.ReslaMoN;Wooded!veal 3).Mine N Worto
IOyes OM
IS6.toucan 011nw SWe ]6e.Cot 0.Tome ' lab.Steel e.Wreer I{ 30c b1.NO. 380 to Cede
•19.Oneie Maw Droned rl Tncc..e.naa.nl. .s...,rv_
ntAel nI.D .reizrnla �Pn,moel ❑Peenew❑one tspe 11
17 6 Ferrer URY Gu,t Of oeti necr ef.18t5Lsm,5 el Coons Ha=omen
el Num Adders And Sc ewe co perm eertMw Caine Of Clean: «.Dense Mir.. 45.Date CM%M
Charles- Heckle MD 406 North 1st- Ave. Vincennes, IN 47659 131 `/ `'� 7 1 1_ ti 6(49
46.Mdoann FmeN Some Putman.
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40.Sato.of Leaal HeaOsOMCer: ''.71.72014'm e9,.Far Reoiiteor Only "Date.led lMmm4Oatlee WI.
os r^ `' • - I• ,DEC 2 2 2010
' . AME DM ENT TO CERTIFICATE OF DEATH(ENTRY ON ORIGINAL)
•
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•State Fenn 53395: ATTENTION ESTATE'Tne SOO.Scan.,e n teen requested by Mrs stale agency m cadet o pursue tntaslery ieipmstb.M.0.itlosoe in veMt.ry and...we ae ere denary to tern.
H.
"`r JAN IO 5 2011
-.Health, Officer • Dated
- This.is a cent fied•Copy ofan.Original Document. I hereby .certify that
this copy:is an exact`reproduction of the Certificate of Death for-the
.,person;ranied.thereinlas'it now-appears-in the-permanent records•ofithe
ICntik:.County Health Department, Vincennes,-Iridiana. Not vali`d-unless
- stamped with official raised.seal. .