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Death Certificate - McKannan, Barbara_6/10/2014 4(4-$0,-0.. -;(1k0gf,,-.3,0,5,kel-5-S.garxtre,FX /5,e-Vatg,.14 - - ' • • - agt•lki,-.4-titne.-R-DiC.Itislic.00.-or0211-4,ia.=V•cxils--='...1kki.V.T2R-If:, -.0a1VC.lialairt• ....„.Itcfece.‘-'51f,ie,,, .;;;;CA 1.'' '41.i...>•?.,r."-n%.?..-' ?i- 0 Inio* AI TA JEDEFf., '1:MENT;19E:HEALTHr;.:-,,,-, '''-- ' ...:::'i •..<:-...;"',::::-:-;:''C'zi- •. .(SntiY- '. L 4 t - -' i •2"`t4oliiiii.016A51C.:60-1-15EWtill. .tric4si:ii. C. t.t.--;•:;. 1• ' if? :-' t;..;_ ' ' --,-- --- Thl ,T.,., - ; -7. - -; 1 ,, :-.: . • ,-z. .: • -:..--ro‘s• • - , .. ......... . s.-.... : .. cit. iv'', 3 f .... . i 1 rlly;---:11 W',:11/ic:..' iitt;i7rgif '-. ';:,:-1 PQ:- ": ., -, -, .-- . - • - . , 1-‘ "c:!vt.L2---...\LoCaliNo b00278', -'' .1 k‘'.-..,EbliiiNoz7000000367e7:73z,,:o(;;F:iirstate4N0 006730---- ,z , :::', ,,- • 1.*Decodent's Legal Name'(First M.,i0dle.Les9„.;i, ,,. ' , -•..o........,i i '5.,1a:Makleri Name(11 feinale);::if t,V''..,1 inkr,.7.1 2:Set,..;1' ", ••1•Tirne Of DeaM.•;' 4. Date Of Dea29%tontNDay/Yearr C":. ,..i'" "&.... d'''-',...: .:,-- :, .”."4, e::, . .., .., e''''.. . ,7 nr-r-i-I'zt .., ‘. • ' ...' ' t, ' / ---4 R1--,"';;,' c,'-',4:--; v41t4t4'444..< :311K-......-2 r ,..,,„, ---.., ; - :i - 1. < ;..< ,, BARBAHAA•MCKANNAN' r '',. ',.. ,. := 1:: :.'"--:::..<,-7.; EDMuNDS>.:S.,;;;. - ;= ....;;.1/41.==. 1=-:;FEMALE . '09:18 PM; =": ./'01/31/2014 1 '''. • ..; .,; 73 ; Molts --, ;,..,; Days, 'i., / ffote417;;72,:i;."i;;: IV/ f"14• '?1c A Hospital,- ‘, i• •, - 5.,_, ',, . , • --, „..... . ‘-, ;,. . je.. . ,.,,,z.; ,„ ,•„. , ....`:-Cct„.. ",-..5y::Z.....„ 0 Hospce F;edy. '0'oefeceiri-HEA, •0;',u;;;N,tiorm&G,itera;Care FiColn - - , , - ....... ,,.... r 0 Yes 121,No 0,Unl‘nov'm 0Inpinent 0 Ernergerry Deparnent.Outiosnem 0 Dead On Anna) i 0 iithaf(a1/4;;;;:a,.;)1 ,,i; ..; '1/4'.....' .,' . " • . , ., . . . • , ;If Facky Name(If Not Insstracc,Give Stan and Nurr.ten: 7 ' ' , s. i; .0. ...,,: .-.': :; "0 : ' - ' " ..., DEACONESS HOSPITAL INC ' '1/4 _ , r= t. • ; ;- ='3 E ' 1. 1. 2 , 7 : ,. ';'. : i • ' t 12.1Cry Or Town,State,And Zip Cade 7 • 1 • ' • 14.Marital Status At Time°Ina.," ••• • i • •' ', - 0 Manisa 0 Maned.But Seilierited 0 Divorced ' . . EVANSVILLE,'IN,47747.. . - . . , .. '1:;;', , VANDERBURGH.. tr.:1/4- 0 Woo;ed,s,0 Never ethod:"0 Unkiioom.. , - • 15. Sunning Spouses Name " . .. 155. (lf Wie)Gee Maiden Last Name „...' --", , „ ;06.-Decedent's Usual Occuption •,. :17. Kind Of BuenessAndustry., . ' ' " ' ‘k->•‘',- :„.'..? -•". 47 :.`, :''' ' \-. ‘. • , 2., ' '', ° ° ' .- ° . 1 • E ' 1 ", A i' -:: • .7-7- f '°- 7 .17 , . ,. . t . ' , ..• ' . JERRY,MCKANNAN ' • ' . ; i ; 1: ; i -'... 1 , . HOMEMAKER ' ' ..! DOMESTIC . IS Residence-State .• • ' - • .- • 19a. County • . ... ,, •, . .. • ' ,' INDIANA e- ' ' - ' GIBSON -- -: 155. Seeet And Number • . . • . i . • '• : . . . . - ; . , 408 CHURCH STREET / • • 0 Yes 0 No • . - ? " ; = = , ' . . ; 47649' : , ; • ; 19, Decetenrs Edit-aeon • ' . • I 20. Decedent Of Hispaec Oncen.- i; ..-' i .,,, '21,Decedents Race, ' , • - . ' ' " , -. . . . . . ' 9TH :12TH GRADE; NO DIPLOMA INOT HISPANIC C.-' ;;• '''' 1/4,.. .''''; VVIiiie. - - ''-' . ,, ; - , . , • • ... „ . -. - ..,:' CC.0 . . , JERRY MCKANNAN ' HUSBAND- i - , ., .4". 4013CHURCH STREET, FRANCISCO,IN 47649 -. •• • .. . ;. ; i.f. 25:11CliCe Of DiscoHoor 5".7.: zr.-"-.. t -, :, . . 25e Method Of Disposition ,: • .. ; '.. 25b.Place Of Disposibon(Name Of Cemetery,Crematory,Otter place); 25c lecaSon-.City,Town,And State ' - - . • : 0 Burial 0 Cremation 0 bonabon 0 EntomOmen ; • )0 ! . , 4; • . . , • 0 Remov'al From State . o crier(Specify): . • • . FRANCISCO CEMETERY ',.-.,. - ."..,.:'' FRANCISCO, IN • .. . . 25.Was Coroner Contacted? ' 27. Name And Complete Address Of Funeral Fealty ".. •••" '-,, t" 't. -:. ...• --‘, C - ' • 27a Fuleral Home License Hunter 0 YeS 0 No RA . COLVIN FUNERAL HOME INC MA INC; N MAIN ST PRINCETON, IN 47670 , , . FH83005671 270 Signahre 011nd:sine Funeral Service Licensee: ?. - - ' ', ' c \ •....:- i % 1 • : 27c.License fruits&(Of licensee), MARK R.WALTER• BY ELECTRONIC SIGNATURE :t . -,;:.:- c ", .' ,, ',- ., FD01013010 _ - • . . -.Cause Of Death,(See Instructions AntExamplee.)•-' -'.. ..• *. Appoximate.,''‘: 28.Part I.Enter The Cnaireth Events'-Diseases,injuries.Or Complications":Thar CiireJy C;usaii The Death Do Not Enter Temerial Events - ' - Intervat Onset Stich As Cardiac Arrest,Respiatory Arreit.Or VentricuLer Fib-illation Wthotrt Showing The Etioloijy.Do Moo Abbre■fiate.Enter,,00Iy One Cause On ' ' To Death •, A Live. Add AddLinal Lines U Necessary. , , • • - • I _ . . Immediate CaUse(Final Disease Or Cdroditicci Restiting ln Death) A ACUTE RESPIRATORY FAILURE , ' . . . ' • - . ; . ' . -,, ... '.,„ . • • Sequertially List Concliiians, II Arty.Leading To The Cause Listed On B' , "-:. : ''.. :.j;. „. ,,' . . Live A_ Enter The Undenring Cause(Disease Or Injuni That Initiated - • , ' .. .1 ; E 1 ' ' , 'r . E - The Events Resutting In Death)Last : ''• -c.4 . . ' ; ', : ' data in 5.A newnimr ce , . . , • . . . , .- - . r ; ; , ,i c ■ i' .• ; . C .. , . ... . . , ' Pert II.Enter°they Sficant Condi:phis Contnbuuna to Dean But Not Resulong In The Underlying Cause Givin In Part I, . 29.Was An Autopsy Perthrtne07 , . CARDIOPULMONARY ARREST SECONDARY.TO ACUTE RE SPIRATORY FAILURE SECONDARY.T9 SEVERE /7,- 30.Were mows;e,,,de,0 Aveeetge To Complete Toe Cause of Demo? .- rCC- "Th 31. Po Talmo=Use C a n i n o-s e To Deem? ':-..2. Ir Female: . '• ; i : ' T C i. : :• ..., - ; •`; i -.; 33 Matter Of(Matt:''. , ' • • 4 . - . . V 0, ' " C '0...re...anon.,Mu 0 Fi...;,-,..,..ir.,:0,pre 0 nut roust,Bpi Hsi.;WC).[42 ter.?:Ho! 0 Natural 0 Homicide 0 Acadent 0 Parning Investigation 0 Yes 0 PrObably 0 NO'0 Unknown , ,„, $ " „Li ma Prneure.eat Purer 0 Dos Ho!sr robs[Use: 0 tie.;wn 0 Pr,4%ara wenn.Pus sent .''4 '0 Sde 0 Coed NG(Be Determined ' ' .:. • : . it, 34. Data Of Inury(Month/Day/Teal : ' " 35:Tome Of Infan ' - 3e.'Place Ot Injury E.G..Decedenrs Home,Construction Site.Restaurant ViAdoded Area) . , • . .i. , '0 Yes . :0 Na . . - . .. _ . 38. Location Of leery-Stra . . - 38a, City Or Town . . t . . I z : .. . . . . , . . - . . . , . 39.Describe How Injury Occurred 4 - . C.... ,. . . . ' ' 41.Sognathre. Of Person Cell:tying Cause Of Death: • C CHAD E:LINK:, BY ELECTRONIC SIGNATURE 43.Name.Address Add Zip Code Of Person Certiying Cause Of Death: ' --C. f. , i : •• • i , ' 44. License Nana , ' 45.Date Gassed ; , . ' CHAD E. LINK 600 MARY STREET, EVANSVILLEHN.47747 ;; '',..,- ;-• - ' ,: 01069268A '' 02/13/20141/4,-, '; 48:Signature of Local Heanl Meer.;s '- -, ',--. • ,r, --, v 7 2Z , ',,,.. "k ; C . i.17 :. • 49 For RegIstrarOnly -Dal,e feed7DACeDVElly/Yeal: --4 1 .7 .•: ;77- 7, 2, ' - RAYMOND-W. NICHOLSON;JR.,',VIA ELECTRONIC SIGNATURE ' .--_-_-.1 ' ::...1..C. .:.-21. ;":' 7. ....: ; . i "...-FEB 14 2014' , ' ; i= , = ; .," ; .., AMENDMENT.TOCERTIFICATE.OF DEATHIENTRY OR ORIGINAL) i : s i :: L. L ? ..-.- jt , .... :- - s •, •/ ; "..,,,' .. C. a::-.)3,--:Ici.-a acoocs--.Iicis----cos :---:-/-zgQ,43-ici - OLI-acclaia-,cos--- ',,. -- , i - \ ...,..,... -..-:•< „ :,. ...,.. , .. . '-‘..>, c°-... 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