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Death Certificate - Bishop, Jackie L_1/14/2014 /<i°^{F:, INVIANA at M IC VCrMrc I IVICIY I Vr I-ICAL In I VLJ1V I ), . . CERTIFICATE OF DEATH V. >J - '�:j Local No 0512 EDR No 000000230602 • State No 051340 1.Cttedsnfs Legal Name(Eat LSCe..e:Last) tt Maiden Name(HfenWe) 2.Sea 3.Time CI Deets 4.Date Of Dead.(MonteayNYear) j JACKIE L BISHOP - MALE 12:25 AM 11/22/2011 _73 Lama I=lays I Has I Minutes 01/25/1938 'PRINCETON, IN B.Emirs U-S.An-.rFns? ._Dea:i Coned la A Hospital: 10a.If Death Occurred SomeMaeD:W Than A Hosytall , - 0 Hospice Fear, 0 Decedents Hare 0 Nursing Honm-ding-tens Cxe Facely S Yes 0 No 0 U n•rc.- 0Ir. ter: 0 Emergency Department OtDalen1 0 Dead on Atonal 0 Ober(speoy) 11.Panty Name(::N::rT__is Give Sued art Minte) 1[DEACONESS GATEWAY :2.Gtr Dr Town.Sate.An:ZA Done - 13.Cw.vy Of Death 14.Marcel Sta]a At Time Of Death 5 Married d Married.Never NMantel Seger-ad 0 W.snws .- NEWBURGH, IN,47630. WARRICK f I5. $utwvng Spouse's Name 15a.(II V/deyGive Maim:Last Nan! 16.Decedents Used OCbpiYCn +?.Kind OI Bmtesveansvy 1 I 'yIMICHELE BISHOP KUNKEL RAILROAD ENGINEER RAILROAD i s8.Resrerce-State - lea.Canty 1eb.City a Torn re INDIANA . - • GIBSON . PATOKA r` 18c.Steel And Ntmber '-`s'- - 18d.API P10. 1Ee. Ztp Code ter.inside City Drib? F D Yes B No 1.12756 OLD HWY 41 47666 7 T' W.De'_ede4Y1 Eauaex - 2e.De•.eden:CI Haparac CnSn 21. Decedents Ram •_, HIGH SCHOOL GRADUATE'OR GED e COMPLETED - - NOT HISPANIC White -If 22.Faints Name(Fen.Mcdt.Leg)_. - - - ' 21 Mathes Name(FRL Mega Lag) I 23a Mothers Maiden Last Name -'I LEONARD C BISHOP __ GOLDIEBISHOP MCCRARY ▪I( gee-maids Name 24e R&M:inex.To Decedent ' 2aa.Wang Address(Steel And Rodger.City.Stab.Zip Code) `tIMICHELE BISHOP .. 'SPOUSE . 2756 OLD HWY 41,PATOKA,'.IN-47666 I .2_Pace et asocsm, I =a.Metod Of Ds=lion 2S•-FFla=Of OsocsZa'.(Name CM Celteary.Crematory.Ogler Pine) 25c.Location•Cry.Ton.And State 5 Bura 0 Caer^.arr. 0 Dona:_.0 En=want.: A 0 Rental Pa.State 0 Oca(Speofyt OAK HILL CEMETERY PATOKA, IN Was Colorer Ceded? 27. Nts Mc Cercle:e d less Ot Funeral Eai:q 27a Funeral Home Lncse Winger: {' DYes. 0 No tip:. "ICOLVIN.FUNERAL HOMBINC_425 N-MAIN-ST-,-PRINCETON,tN-47670 _ a- + FH8300567 -----7- -.-1---L 72 $ig'e a Indiana Funeral Sensce Lkensee . +e +'• 22c Ltense Nvmeer(Of LOenseel =JOHN W WELLS,BY ELECTRONIC SIGNATURE _.. _. - . . F001009940 ?5 - [ a-:' 3 Caine Of Death (See Instructions Ind Examples) Appredmate 4 .a s^S s Interval:Onset ▪ 28 ott An ardia Toe a is cc1 - Oscar rrcda. CO nnkcss-, 0.•ede Uuogy Do Not A r is o Di etOny One C Events sA ALt . 0dAd.-.a LRn i2x' -2' Or er-ex+vi' -3 S-€0,31 TTeE+idogy.Do NOt ASSm•ae"..n:er,ONy One Uus<Or. To Death A Ike. Add AdiUa'L•n nH♦e-_esscal•." _ -n <1.1 i L-mediale Cacse(re'at Dist/CY CO-ari .s-- 5 Do ) .-:•-METASTATIC NON SMALL CELL LUNG CANCER 4 YEARS -,iM1; �;, N.a ter.,.ce..e...n- . . _•14 l ‘7 it -F▪ Secuntialy list Cala:ions y .y, erse U3 O aw le,a.,.we...err A Isle A. Enter The Urkaiyin Cz (Diverse rl-1i97) a ks' TAe Eienta Resulting In Dean)Las( C -Z s}. . ,.m...w.een on a' iPa..-111 Eater Other$ie-+`rant ConO Oortsr-,.-a-cr---no Co c}Y-s;NU SS... F roe WY-Setae GF+iv In vent 29.Was MA;nopsyPMOn:ed? I 0 Yes 0 N 4- 30 Were e araaF aa4 eV Avaade I To Co-yete The Case Ol Seal? ❑Yes ❑No : O4 io!arOd U•J.Cm+rla:2 is Del.a �. 'T-�e- 31 Aann Or sR F {I- Chew 0 wa ❑,va.vxw a •naaa ®wlvraa DH pvao ae DZCmI ❑PCVap Investigation ▪ FI Yes 0 Pooady 0 Ho 0 .. .s.M 0 u..,e..a,.se s:a.ey- 0 SUtCe 0 Call lea:Se De:e.tied Cate Ol Injury(Monnnadvearl 1{11$ •" _f+ Para Cl L-,ry(-G_Credats Hoge.CanWpm Ste.Restaura:t%Yxded Ana) 37.Loamy WNW.? N;) •,�v_ .I _3 I DYes Dino 2' "1i.Lxaym Of Injury-Sate -~yCr Town 345. Saet&W.rr_•a 3EC AR No. 394. Do Code arTx Hem Inlayoc:nad 4O.dTr Irnxs ty Ii lllill S.I.Sgra5re.C Person Cenyt g Case Of ter Z'C- - 42.CertSer(Caeca Only One) ▪ ANTHONY W STEPHENS, BY EL_CIRONICSIGNATUR ©Castyiry My/ban 0 Caaaer O Meth axe <a .Name.AMress And Zip Code Of Pence Cerjc Dar..iie Cf Dean: ' - • - 14.License NUnter 45.Date Cease - ANTHONY W STEPHENS ,3699 EP:VORTH ROAD.NEWBURGH, IN 47630 01040406A 11/23/2011 r•)_c AMaabl Fneal Service Paoader -,4". 47." 4?. Akan: . F,'f se.Sgnattre or Load Heat,after. _. 49. For Registrar Only -Date Feed(MorAMDay.Yearj 'RICKY B YEAGER,VIA ELECTRONICSIGNATURE . : . I NOV 23 2011 _;I: -�Ct)`;-"AMENDMENT TO CERTIHCATE OF DEATH(ENTRY OR ORIGINAL) I �a^`.+ 4Slate Fm_m 5:395 ATTENTION ESTATE:THe c Seamy:is being reri ss a 27 r3 sate catty In eater to wrsue respansibeiy. Oisdosure is voluntary and there eil be In penalty for rallsal. ?�m�a�.. K' IS-20 _ E:-art S __ p.•>-..,ter __----�n�°"_ _ �i; a ' (7/05) ��?VOID IF ALTERED 011EHASEP NOFIIAL10:UNLESS CERTIFDD:BY:HEALiH DEPARTMENTS YTS ....r`- .--sa�,r. __..-Tar- _ .. _.-tea....-,,, - = 1= P -Yra r' •-' .t J(. ) -_;� ._ - I