Death Certificate - Huff, Howard G_6/30/2014 EININ7nT:Ittl aily1WR41rl4ID8ilniPeg14Palillllil Ultft:141141✓141feil rl1111If19r:1fCN1:14941slI:it ITI L'LLa
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2 "-'•a� INDIANA STATE DEPARTMENT OF HEALTH 8 97 459
r ?I CERTIFICATE OF DEATH
Local No 000113 EDR No 000000388183 State No 024838
1.Deceaenrs Legal Name(First Riddle.Last) la.Maiden Name(If female) 2.Sex 3. Tore O10ees 4. Dated Death(MOnoWayflear)
HOWARD G HUFF MALE 08:55 PM 06/02/2014
78 Months Days Hours Minutes
❑Hospice Fealty El Decedents Hone ❑Nursing Homelong-teen Care Faoiy
0 Yes ❑No ❑Unknown ❑Inpaent ❑Emergency Depamnem OU:.atent ❑Dead on Areal ❑Otter(Specify)
11.Fealty Name(It Not Instttm,Give Street and Number)
200 SOUTH WALTERS STREET
12.Coy Or Tams.State,And Zo Code 13.Carry Of Death 14. Man=Stabs Au Time Of Dear
0 Manned❑Marred.But Separated ❑Divorced
FORT BRANCH, IN,47648 GIBSON ❑widowed ❑Never Mane' ❑Unknown
15. Surviving Spouse's Name 15a.(It Wee)Gwe Maiden Last Name 16. Decedents Usual Occupation 17. Kind Of B;snesslndustry
OWNER AND OPERATOR OF
BARBARA L HUFF VOELKER HUFF ELECTICAL SERVICE ELECTRICIAN
18. Residence-State tSa.County 180. CM Or Torn
INDIANA GIBSON FORT BRANCH
18c.Sveet Atq Number 18d. Apt No. 18e. Zip Code 18f. Inside Cey Limits?
200 SOUTH WALTERS STREET 47648 0 Yes ❑No
19.Deceosers Educator 20. Decedent Of Hispanic Origin 21. Decedents Race
HIGH SCHOOL GRADUATE OR GED
COMPLETED NOT HISPANIC White
22.Fathers Name(First,Riddle,Last) 23.Mothers Name(First Mirage.Last) 23a.Mothers Maiden Last Name
EDGAR HUFF EDITH P WRIGHT HUFF
24.Inkmtants Name 24a.RelatcnsNp To Decedent 24b.Mang Address(Sven And Number.City.State,Zip Code)
BARBARA HUFF SPOUSE 200 SOUTH WALTERS STREET, FORT BRANCH, IN 47648
25.Place OI Ospo eton
25a.Method Of Dspositon 255.Place Of Disposition(Name Of Cemetery.Crematory,Other Race) 25c.Locator-Cty.Torn,And State
❑Burial ❑Cremate ❑Dona:on 0 Entombment
❑Removal Fran State
❑Other(Specify): HOLY CROSS CEMETERY FORT BRANCH, IN
. 26.Was Coroner Contacted? 27. Name And Complete Address Of Funeral Facitty 27a. Funeral Hare License Number:
❑Yes 0 No STODGHILL FUNERAL HOME INC, 500 E PARK ST HWY 168, FORT BRANCH, IN 47648 FH10900013
27b. Signature Of Indiana Funeral Service Licensee: 27c.License Number(Of Licensee):
ROBERT S STODGHILL, BY ELECTRONIC SIGNATURE FD01024378
Cause Of Death (See Instructions And Examples) Approximate
29.Pan I.Enter The Chain Of Events -Diseases.Injuries,Or Complications-That Directly Caused The Death.Do Not Enter Terminal Events Interval: Onset
Such As Cardiac Arrest.Respiratory Arrest,Or Ventnaaar Fibrillation Without Showing The Etiology.Do Not Abbreviate.Enter Only One Cause On To Death
A Pale. Add Add.tinal Lines U Necessary.
Immediate Cause(Final Disease Or Condition Resulting In Death) A. ALZHEIMERS DEMENTIA TWO YEARS
as ern A.A C4.y.4.
Sequentially List Conditions, If Any.Leading To The Cause Listed On B.
Line A. Enter The Underlying Cause(Disease Or Injury That Initiated at..la 4.•Gowan on
The Events Resulting In Death)Last C.
M eta Axe Camp.-,.On
D.
Pat IL Enter OrterSionmcard Ccndruons Cetntimm»But Not RIsult g In The Underlying Cause GMn In Pan I 29.Was An Autopsy Performed? ❑Yes 0 No
RESPIRATORY FAILURE 30. were Autopsy Fuddle Available To COrnplee The Cause Of Death?RESPIRATORY 0 No
31.Did Tobbacoo Use Cant-tome To Death? 32.If Ferule: 33. Manner Of Death:
No Unknown ❑r..n.w.Se„r.ds.. ❑ey...Ai Ts.bogie ❑r..wwww.St Pr.n wee.4o.,s or o..., 0 NaT=❑Homicide ❑Accident ❑Penang Investigation
❑Yes ❑Probe ly® ❑ ❑ale nvw,.90'n...43 0474T.,ore etc.o..e ❑utw..t.lwr..w..t TM Pr w. ❑Suicide 0 Codd Not Be Determined
34. Date Of nNry(MonflDaylYeear) 35. Title Of Injury 36. Place Of Injury(E.G..Decedents Home.Constuctwn Site,Restaurant Wooded Area) 37. L wy At Work?
❑Yes ❑No
38.Location Of Injury-State 38a.City Or Town 38b. Street 8 Number 38c.Apt No. 36d. Lp Code
39.Describe Mow Injury Occurred 40. It Transpmap":lryvy.5 y
45.Signature.Of Person Cif.}ilg Cause Of Death: r" t 42. Cel1_er(Check Only One)
LARRY WILLIAM LUTZ, BY ELECTRONIC SIGNATURE _ _ - ®Certifying Physician ❑Corner ❑Heath O:cer
43.fame.Apeess And LD Code Of Person CC.Syug Cause Of Dean.' 44.License Nornse 45.Data Ceeed
LARRY WILLIAM LUTZ ,802 E.OAK ST., FORT BRANCH. IN 47648 01027538A 06/04/2014
46. Additional Funeral Service Provider , 47. -Akan:
48. Signature of Local Heath Oflcer. 49. For Registrar Only •Date Filed(MmttDay/Yeap
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE JUN 04 2014
AMENDMENT TO CERTIFICATE OF DEATH(ENT.Y OR ORIGINAL)
°: jb - Iq-I -303 - DOO. 3yb- oa(0
•Stab Form 53395 ATTENTION ESTATE:The Social Security a is being requested by this state agency in order to pursue responsibility. Disclosure is voluntary and there will be no penalty for refusal.
NRA-20
(7/05)