Death Certificate - Frohbieter, Lois June_12/18/2013 - ,:renvu1RR$a9d191: v'
`�_", INDIANA STATE DEPARTMENT OF HEALTH 7 8 6 3 4 8
n;7 :. CERTIFICATE OF DEATH
`4 Local No 000155
I.Decedents legal NLocaaStMMee,L� EDR No 000000242538 state No 004251
it Mat Name Of lane) 2.Sex
LOIS JUNE FROHBIETER '' Tors O1 Death • mt«Om,plawOayyye.O
79 Matte
e°"'es 01/13/1933
GIBSON COUNTY IN Ever U.S Amed Forces? 10tl Death pmneathANOa,>< otU Death Oconee Somewhere p Yes ®No p Unknown 0 aperient 0 Emergency Department d4asee p eed a Areal Q H Filer ffir CI DeaerHap 0 •Ca.Fethill
11. Faoety Name Of Na Insetution.GAe Seel end Way)
VNA CHARLIER HOSPICE CENTER
a Canty Of Death
14.Markel
star At Terse Of Death
15.SMa,vag spat.mane VANDERBURGH p i MD But ❑Divorced
,Sa of keu the Mortis lea Name 18, Desde,fa Used 0tytnam
ORVIL EMERY FROHBIETER
Occasion ,T. IC.,d«am,e:aa
18.Resides.Stay
INDIANA +� Cater im.CityCr Town HOMEMAKER DOMESTIC
+m R Am Mate GIBSON OWENSVILLE
7324 SOUTH 500 WEST 1m A N4 tat zb Code 181.httile City Units?
19. Decedents 20. Deeded d lfv�digit ❑Yen ®No
47665
9TH-12TH GRADE NO DIPLOMA NOT HISPANIC
a FdlYa None(Fast,Wale
23.Mothers Name(First Meee,last)
DARWIN STONE REDMAN
�` "1°°"�"Nen'
za.11tlb1n'"*,NTO ALMA LEE WHITLER
24aReaamm�ToDemee 2b.Moray Ada as(Meet Aid Mahe.any.Stmt Z,COB) OVERTON
ORVIL EMERY FROHBIETER HUSBAND
7324 SOUTH 500 WEST OWENSVILLE IN 47665 •
25a Method d Disoomon Other
®Beal p Crenate p Donegan p Entombment 750.Plea«dapsl8a(Name Of Cemetery.Cyr.Otler Rae) 25c.!atom-any,Tam.Are say
p Removal Fran Sty
p Other(SPerary CLARK CEMETERY
18 Was Carona Contacted? 27.Name And OWENSVILLE IN
Complete Agana Of Fealty
❑Yes 0 N HOLDERS FUNERAL HOME OF GIBSON COUNTY, INC., 319 SOUTH MAIN STREET, 27e.Free Hoe t m e a.be
Vb. SiatatMe Of Wane Fie.SeypeOly �SVILLE IN 47665
RANDALL K DIKE BY ELECTRONIC SIGNATURE FH89000021
Tic U .Nunes' Ucedeey
M.Pat L Enter Tie Cate Of Death (Sea instructions And Examples) FD01010177 Or Camartabons A Lie. Add uer l)a�l Lines�N •F�rdfatan NV1gW-$hoaitg�Ttny Cawed The Death.Do Na Eater TantW Events
A eevat Mt
aRany Arrest Or Ve,tbt
eaazay. Etiology.Do Na Abbreviate.Beer Orgy One Corral On enemas Onset
Immediate Cause tel To Death
Disease Or Co ceion Resuthg in Death) A METASTATIC COLON CANCER
• •.
Seguentiery List - 3N£EKS
Cames,o a Any.Leading To The Case Listed On B.
Lis A Enter The Undertyic
The Events Retultn )last ore Or trryy That treated to . ..
C.-
•
Pa1LL EN b
SOec:. -�.-.. m__ D.
.
.S�s OKJ But Not Resitting In The Underlying Cana Chin In Pmt I
29. Was MAUagay PoT.,,+et
NONE p Yes ®No
31.Did Tobacco Use Contexts To DeYM 3T. BFents: �.Were Areapay FVe°G AVa4ga To Castee,e The Camdpn8n
❑Ya ❑RrpeMr®No ❑umnoen ❑eae•a+v aetr..r. ❑MeeeNlY.aor rr 33.Mere d Dealt p Yes ❑No
N. Daee«hFryLM aYryeer) p roast u F 43 Dap To t rams.or 0,swe.novar Rs oao� 0 Nagai p CaE Na eDe era e 0 Is°rm'9 a^ m
35. Tone d Irµ.y 38. Placed Suidtki Rest❑ ' de Bseabmd,sd
tTuy(EG,Decedent's Hans,Camiru9et Sit.Rastarae,Waded him) 37.(dry A+Y.trK!
33' laca<an«aryy-yam Ma.Car Or Teen ❑Yes
380. Street 8 Mater
p No
38c APL No. 386 T9 Cade
38. Describe Now spay°came
41.SVtata4 Of Person Cetfy'ry Cane OI Dee _tl Tla O BIaY.�edM p�A�
'ATRICK C. FLAMION BY ELECTRONIC SIGNATURE Ell �) L.1
M L. 0 Canner p I,eM Oma O. Name.Aches.And Tp Cab Of Place Ceteyig Cam Of Death
'ATRICK C. FLAMION 801 ST.MARYS DRIVE# 110 EAST EVANSVILLE IN 47714 po/01/2
6.Addaaa,e Fars Samos Prams 0 7 'no.:0A
47. •Alga: 02/01/2012
8.Samba of lase Health Otos
AYMOND W. NICHOLSON JR. VIA ELECTRONIC SIGNATURE 49. ForRegistrar dvy -pat Feed Wo,evO.yyya.y
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) FEB 01 2012
ck
b ram 53395 ATTENTION ESTATE'.The Social Security q is being requested by this state agency In order to pursue responsibility. Disclosure is voluntary and there will be no IVRA-20
:'' (7/05) penalty for refusal