Death Certificate - Harden, Reba Faye_9/2/2014 ,7-.-H-re:-.(S:7:` a 7_ 7 A CERTIFICATE OF DEATH _...r4.}�%�r i r`-y@ s r % ^:
ill C; _" INDIANA STATE DEPARTMENT OF HEALTH
=�'i.11 f CERTIFICATE OF DEATH 0 ,,
'-? ' Local No 005876 EDR No 000000398899 State No r
IREB1Dececent's legal Are(Fri'Jade'act
A .a Ms]en Name:11 lank) : Se, 3Tend0'Edda. aOat.gDen (MonVSPfltVev. ��(t""
,'AYE HARDEN CUNDIFF FEMALE 08:45 PM 08/07/2014 5)
82 morn I
Days I Haas I metes I 07(1911932 COLUMBIA. KY _
3 Evea.0 i Armes Forces'' i 1011 Can:Cm i:e'.n A roma! 10 It Dean CmrteO Sanewnere Ores Than A!o5'2:al
0 HOSa:e Fans} 0 Deceirts Hare 0 PLrsng Ncee'_vg te,m Care Factory
Fes G Nc O U,Aren I G moment 0 Ene:9ency CPrarn'en ama•.ert 0 Deaa sr Arlr.al o Deer lsxehl
11 =eery Nene III trot l4.a.00r..Ova Street arc`N^oeel Ii
ST VINCENT HOSPITAL 8 HEALTH SERVICES t;
12 SIN Or Town Stale.Ana 2e,Cede 13 Ca.rtiOfDUn 14 Mental Status At Ime CP dean
- ❑manioc 0 Man e: But Separate] 0 Divorced
INDIANAPOLIS IN 46260 MARION 3'Mewed G Newer Mama 0 u•rown
IS Survrang Spaces Nose 15a ttlV.Me cove Mabee Lan Name 16 Demmer s Usual Ommaom - 17 fie 01 BssnoVn3sri
SUPERVISOR MANUFACTURING t
la Re9Cence-State :ea erne 1® ON Or Town
INDIANA GIBSON PRINCETON
lac.. Sue And Ni ncer led A:1.No Ife Zr Cone 'm Enact ON car..tn
1659 OUTER LAKE ROAD 47670 0 es G No .,'Sid'
19 Decedent Edccaoot 2'C Decedent 01•start:Oren 21 Cosecants Race 14
HIGH SCHOOL GRADUATE OR GED
COMPLETED NOT HISPANIC _ White
22 Fathers NanelFnl Mdse'_15' 23 Mothers None IFt5L.Middle Las) 23a Meters Made,Las:Mire
LESLIE CUNDIFF ANNIE LEA CUNDIFF COLLINS
24 lr:>6anrs Nome 243 Reaemsap To Deceom: oar Mates Address(Stem And Aimee.Ctr Stale Un Coo,1
GREGORY Y HARDEN SON 1703 OUTER LAKE ROAD. PRINCETON. IN 47670
35 pile Or]scosoon
25a Method C(Dspos::r. Z_e Place b Dsecsem. Ware Of Geme•ery Der oti'.One Flax) - 254 Location own M]iate
G 3rd 0_rese tt 0 araaal G En:oncment
G'area'tar Sate
G Geer ISCe.,I COLUMBIA WHITE CHURCH CEMETERY PRINCETON. IN
26 SeasCoroer C.on new 22 %a.re An:Croete Aires Olt/mere Facky Na FAeni crone LCenae:tune
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0'es G rte COLVIN FUNERAL HOME INC.425 N MAIN ST .PRINCETON. IN 47570 FH83005671
2i] iq'ale Cl i mina F:r'Ca Scent Lcensee 7. b3'nde NUnLe IOI•JCmSetl
MARK R.WALTER . BY ELECTRONIC SIGNATURE IFD01013010
Cause Of Dear (See Instrucoors And Examples) epednrax
25 Par1 E °era Diseases ertnes.Or Ccncicators-T of Ounce,Causer Ina Dean.-Do Not Ante,Teoral Evens Interaa Onset
Saar As Caaac Pies:Respirator,Aires:.Or'ienneial Fionaa:en R'otost H2 s'cc The`_,obey Do Not acorevla:e Enter Orly One Caste^.n lc..ca_.
A Lee Ado Ad=d nal rues It Necessary
Irtreaa:e Cause(Final Disease Or Can, er ire-lcpg In Death) A S DRT EO'AEL Si'!DRONE 114EE< —
Sea+eaty Ltd on Goodt I:Any,Leading To ire Cause'I>ea re, d DEAD EOwEI -Y�- 114EER
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rare J.'cerr,- 3 Cause(Cl eease Cr Iq:y That In-rated
TeeEvensResua.nclnDeaclLas: C RENAL a L'eaRE :•AEEA
^ii trier `re'S,gntcantCme]ms Com.:1i'e Jean Burt Vol Res.'.trS r.Ore temeRT3 Carta UV In non I:9 lASXAtt5tSy a.r..eC%
0 Yes Q' :
I 'a 1 30 i ere Anoow r rong A•a4tle to Gnn4te Toe Cause Or wan'
i 31 -Dec r.o,aa Use:anra..e m Cleat ' 22 rase 1 33 Mw'ner a Deal'
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l4 Oa,C . evaraeer,{{ 35
Ire 011. i 36 nace 01 L'Strl DEG Demlers Hone.=rsn.nm Se Restaurant.Aceted Star 1; lnvl At Aon'+
G Yes 0 N Li
I?.9 _canon CA Iryv}-Sale 12'a ON Cr Tar 310 SSeet 3 Newer I Mc Apt"ea Sole Zn ace C
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39 ,Cesar:e-cm In,trr Octave: 0 r: ..... . . /„fr.:;.
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I : Sayan-re 01 Paste Ca:t�Cause 01 Death a2 Cemse,O'er(key D•el C
SCOTT ALAN HANAN . BY ELECTRONIC SIGNATURE G=etivn9 F*3s G caan 0 crerorm 1i
(43 Nana.r-acres Ma Ls Grid'}aerss Cerlanng:als C:Dean as Ucenu:tracer a5 Ore ten:ea
SCOTT ALAN HANAN 8433 RANCOUR( ROAD SUITE 100, INDIANAPOLIS. IN 46260 01052073A 08112201 e I
46 Acs a-a Fneal Sammy Ya•as ( a7 'fleas
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s3 yeve-o¢I-Men Clear 43 Far Rrgntru OWN "Cale=Ten.raow[afna'r Ti
VIRGINIA A CAINE.VIA ELECTRON:C SIGNATURE I AUG 15 2014 4
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) FPPI
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