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Death Certificate - Whitehouse, Oscar_12/19/2013
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OSCAR VVHITEFIOUSE.:5! s-/"';`,, .%..." ; i %../ .."//451:-.5;:". ..c...-5.%.i..k:.53:.3:5-1 .4c1...t. ":%. ., F.;%" 1.•443:..'5.:3:MALE.5.:. '."'■ 03:30 AM 1c12/0412013.1 -3r7-',,,, ?% : 77 3 . 149^-1)? "...,-; Pals ': i 't!PI2a--f...izi..--; 92g11413.,,.. .:?,-..:-: ?....i3-3.5.....,11/03/1936: 55- I FRANCISCO,IN f :.;; "..,',' % A % 9, Ever in U.S.Mood Forces?- 10_II Deam Ocarred In A Hasps - -''" , ' N.r--,'',.;"i: 7,10a Ilf Death Occurred Sorne+Awre Onlee Tnan A Hosortaf.: t ; •, -- ...; . :,,.. "," -``,::' '; ''''' '4" r-:'''. '''''''' , ''.11:.' '<,..t„--ci-l.J''.:::1;:"1 0 HI:1*e FicOYC,:0_,Oecedents.!-IcrOe' O'NLIT,anJ HPTal.ccinglir.."'„CareF.,catT,. -„'"."--cZc .-% 0 Yes"0 No/0'Llitto-sova; 9 Valiant 9 Emergency Diadment rijil,,ara 0 Dead onAimial ti-61:,`,4.. p-;:ayi':' .- ;:c> ;. ) t''. :• ". ;" '..• N', N. +N - i11:;;FaeLty Name;(If Not lestitnon.Give Street and Number)S 7 ': - ";: % %-- z '. •;".:. -: :/ • ',.r %; t, 1: i % c ' I : i. 1 - ' ' i : .:.5 :‘ DEACONESS HOSPICE CARE CENTER ' F: ' ; ,. .:•: -: --.3::':5.3;:3:r:%--- ' , '2; ' i %. , ' EVANSVILLEJN.47747. %/...-,/% , ; •. , 5 .:3: ::::.;:f •:; ::;.- : : VANDERBURGH . .%.5:.t.:/: 7: /15. P v.'""&"^"..:: 0'Iliri.LiAjirriec/-;tO uniklor12" 15 Ssrvswsg Spouses Name . / 15a (If rite)DIve Maiden Last Name-•'C. '1 .3- „ 4 16.-.Decedenrs Usual Occupabon . ',.. pi Kind 01...Business4noustry ,.... 1 THELMA WHITEHOUSE- ' . ; ; , : . WHITE :.% L% .% : -%, % . 1:: EQUIPMENTOPERATOR COUNTY GOVERNMENT' . , INDIANA 5,'.., ./ .. 72. : - GIBSON . "-:":.. 1:;:;:":%%.. ..:5j:C.%'..",• FRANCISCO % ..%" '.., %J.- -,. .., I. ?.. 15c.Street And Number - • . , •• 1 : ".. "...,..-. : '7 '' ../, 1 ", . • : ' ' ' ' t ; ' ` . 6620 EAST ROAD NORtH • % 1 . ... -. , .. .: , ; ; D Yes 0 No & '' ' ' 'z ".-% %• %::- % , % y P -., - % 47649 Z. . . . .. , .. . HIGH SCHOOL GRADUATE OR GED ;:. . ', '; '' / ' %.- ' i ' 22i Fathers Name(First.Mane.Last) ' ' • : . .- - 5 23 Mn(s Name(Feat.Malls.LsatJ'- . 23a Moth&s Maden Last Name i, ; . t " ', t, 3, t':, tt.-. t. ‘Z. t ... . ' t t t ; %' • , ROBERT.WHITEHOUSE i ,%: % % AoNESWHITEHOUISE r- ' -: : ., : %, KENDALL 24.informants Name ' • .. 24a,RelaacciStip To Decedent: : , 245 MaNng AddresS(Street Am Murder.Qty.Stale Zip Code) ' -' : '. ," -• , : 5 ,... . ‘ j `. -„' „; THEL`MA WHITEHOUSE ' , WIFE.. ; -", ...%%.*C: 5-'7%2:: 6620 EAST 350 ROAD NORTH, FRANCISCO, IN 47649 . 25a Method 01 Disposiben , ', , 25o Race Of Dispositon(Name Of Cemetery.Crematory.Other Race); 25c Lccaton--Oty.Town.And Stale i 0 atrial a Cremation 0 I:im:on 0 Ehtembroant . . El ReMoval Frcan State„„ ' : . .„ . • . „ EL OlnerISPeaty): e: ; '„ .; MT OLIVE CEMETERY -5:. ' ..-• /.. -:' HA2LETON, IN -. .' .. - . . . . •29 Was Coroner Contact's? ,• - , 27, Name AnO Complete Address Of Funeral FaciStr---... ,,,,'-.. .53. d'r,:.., -...,-'',, ,-- ,,,, -• - ,. " ,', ,27aFuneral Home license Number. ''', ; : ' ?i ,, ,. • , 3. DOYLE FUNERAL HOME. 520S MAIN ST, PRINCETON,;IN 47670. % i . '. , : ‘. FH10400010 1 ,275 Siamese Of Indana Ftrieral Service licensee: : * s '.7' ',- -- ; • ,:. ; :. .: 5- 's ` i 27c License Number(01Licensee). BARRETT:W. DOYLE, BY ELECTRONIC SIGNATURE' : •- ,- ', . :r: : :. -, 5L t: •:...: .- ,' FD29500009 r '„ '''. r ; / -',, ....5, - ■..... ' • , ,oause Of Death (See Instructions Anq Exarposs) _ t, E - •-25.Pant Enter The Chars Of Events;.Diseases!Nunes.Or Complications-That&ICA/Caused The Dal.Do Not Ente,r,fetlitinat Events"* -; .7 . . `. Inter;at.Onset "•• Such•As Cardac Arrest.Respiratory Arrest.Or Ventricular Fibrillation Wthout Showing The Etiology.Do Not Abbreviate.Enter Only One Cause On • To Death A Unit. Add Addtinal Lines If Necessary_ ' .' ' ,. : ' 5 ''. C: e.- .,i / , • . .' : '; Ithmediate CaGse(Final Disuse Or Condition Resutling In Death) ' A : RESPIRATORY FAILURE i '.. .- :.: , : . t , , , , ., . , 'DAYS „... . . . .. , • Sequeitally list ConditOns,If Any,Leading To The Cause Listed On B COLONCANCER Line A: Enter The Uridedying Cause(Disease Or Ins)That Inztiated; '', C ''''; ..,'" '''',. 777.'-: : 7 i .-- N.. The Events Resulting In Death)Lst „'' ' ' ' , ;°tn.'''.4 A eta"7.°1 ' ' ' ; - ' ' ', • -: - : I 45. '., . - i.7: 7: : .1'„ : : :7 " : , . • . iPan II.Enwr O9)er5sni5cant Conctons Contnoutno to Den But Na Result:no In The Cease Gavin In Past I, ' 29,Was An Atoo?sy Perfonneo,I- i, LJ,.., • r. --- , : : yea' lot No , ,. - '-••.' 31 Did Tobacco Use C,cctibtde To Death?, ' 32. If Fernale: -.' : 'i ; : r ‘c:H. t i ,:: ..•-• '-. ': = i 33- l'!4arrpf D.-82t 3 • , . Si. t -.- ". - •0 ra vw 0 n134!mMl 9 neVoiml0 Dn.Of Cat 0 Natral 0 Hnvacke 0 Aieni 0 Penang nves•b'o'.ano:n 0 ies. 0 ItebablY 0 No 0 Unknown 0 4o :T. SM.03a 0 SUcde j C.id Nt EDelerinned 34 Date Of Injury(MonINDay/Year) t, ,•- 35. Tone Of Injury . - '„, ,38;place Os InAry(SC.,Decedent's Horne:Construmion Site;Restate-am Wooded Area) '._ '37. Injury At Work?, ... . . ? .. „ c i N : .:.'. : ‘ . , ., . , .,_, , - -39.Den Now Irtury Ocorrec : . s. . .' -; : . ,. , -_ .. :. --i Pa IITransPa IAPP7. r Y., .,- , - ,, . r b : ,.,,,• ._.,...,, ..,.„..... • . .. -•.... - ..„ . . •at.,Signature,Of Person Cat:tying Cause Of De-ant 4 . , . DOUGLAS:JAYE HATLER., BY ELECTRONIC SIGNATURE .5% . '''''' ., '. %. ,:• / 0 Cerlifriog p56en -'0 coroner 5 - 9 HeatiOcer E. .: ''• N.,,. 43.,Narne,Address And Zip Coda Of PersonCert4ing Calne Of Death.: .' -.: t t )a C t 2 . ;-1 ; ": 441 license.Ntrnber - 45.DeW CerzLed . , • : • ' • ' i : 1 , ,. . DOUGLAS JAYE HATLEIet, 4498 FIRST AVENUE,‘EVANSVILLE, IN 47710 '', -/' ....; 5. -r- •: 01039937A ‘. : .5.. ', ... '12/10/2613:„..., „e „, ,, ,. , , 48-",sran 0H-0,,a Illtm Dear:' "\ `'5 , 5 -.- : - /fin,„ ,,t ,;;',, .•."• ...."--.;> 5 ;..,. 'i-,:' .-..., 49. For Registrar oniy„r.Flate Filed (Mornh/Dayri ear):",„„; -'.., ".•., ;i. ;.`",s. %-.., RAYA;IOND W. NICii-OLSON,:JR.;;VIA ELECTRONIC SIGNATURE I,._--,4, rri-:-,.. . -- , .; c."-.. I : "5DEC 11 2013 4 :•%:; ;; : 5: i 7■7 t ":., n. ; AMENDMENTTOCERDFICATE OF.DEATII(ENTRy,OR 0/11GINAL) y ;,, I S sL '.- zi t.: )- att , • T. at: ft Vt,,,,y; i ) a.L.,/ " .";" ;' .,, ,,,,i .15. :C'">'i !1//:i!.„:erf:Wre-r; i Rfrt:n z;;--*f..■V:i" i '`.5,1,•'. -: ri. 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',7 i P.e .• tt-:I -.tit: :'-. :1,:::. ..--.:: .", ..-7.- :.; :S ;- '" - ::S:::::,1- 3-;.;•;,:::;`, . ;-;,;.13:1;..3.:::•4•13.1.„...,..,:,;; ;,,-,:czA-:...:3 ; .;3., :3; -..: 1 1. :; 31 .3... ..:• 1 ; .; Sta:8 Form§339.•ATTENTION ESTATE:The Social Seciirit)i Pie being recaystecltfrt1jjs'State egisg4Iiirefer to prop-iii IiiicstSS..tEAfrilOiSCkEribrie?s iolimlafir and?Ace will bitio.pinally f9r refusal_ 'k' 1: :.3." OPOGI/IAC DOO‘lAttafT HAS ArMISTIbOLOSEli SACKMOVNO.014 SPEGLAt CA(sTeSEDURIDSPAPF34 AND.IIIE GREAT SEAL OF il4E STATiOkinitika ON BACK TAAT(c...: .:;;;E:1--sWARNING: TURNS FROM'ORANGE TCPtELLOW WHEN RUSEIEWORIGINADDOCUMSHT HAS HIDDEN DIciON FRONTTHAT APPEARS WHEN PHOT6tOilEO,Z.:;"7"....%.-'';',Icr-,FTt',3; 1 .