Death Certificate - Miley, Richard E_10/22/2014 � yea°.-� -�:,._.�a-.:�->=�� =°'Win'_ :4..�:���a��:. CERTIFICATE':OF,'DEATH:_" mss' `'s� T-r - ��` "-�`'r " °r y.,-.,� -,s
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m INDIANA STATE DEPA'" NT OF HEALTH '
1`4 CERTIFICATE OF DEATH -
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• • Local•No 008164 - - .. EDR No 000000351122 State No
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RICHARD EARL M�ILEY� - - I
MALE I 07.15 PM I 10292013
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Homed -- _,
f (3 Yes Na Ur.R,dwn 0'Imps Faoat 0 Dicuenrs:lane 0 NMSng Hanatag-lam Cate Frey s.
El roue,'O&nowt"Cmatmnl Duvaiel 0 Deed on Nnvd 0 Oe,erISpeoNI
la rear/Nerve ill Hot ss sar.Gee Steer Brace Maaeul
- INDIANA:UNIVERSITY MEDICAL CENTER •
tr•Otra TOM.$NM Mt La Co* 13 GYNt Of Dun 14 Mental Slade Al Tee Of Death
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•' •• - .. m Manel0 Mmea.BM Separated ❑Ooacad
INDIANAPOLIS IN-46202 . . - - MARION - 0 wacnd 0 Nero Mown 0 M*.man
• '15 Sunning Spouse's Name _ - ISo III W!etexe Mean Last went Ifi. Deserter*a Usud a'nrpaton 17 land a BrmnesfIndsry
.- DORIS MILEY - - • ZEHNER • - COAL MINER MINING
• 18 Reseeme-Slay - ' ;Fa Cann Im Ceea Two
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INDIANA. t - GIBSON - _FRANCISCO
tEe. Strad AN Nance - - 180 Apt,-No. t4.Z9 Coy IN tum ON Lams?•
5534 EAST 550 SOUTH .:.- .. . . 47649 0 vet m No
19 Decoded'.Eauban ' - 2n Decedent Of ttspanc aqn 21 Der deuce Rom
HIGH•SCMOOL GRADUATE OR GED - - -
COMPLETED.- ' - NOT HISPANIC White . -
22FW1M57tSme(Ent.640e.Lag/ - - _ ., 23 Mother's Name[First Mda,,last) -73a Money's Madder Last Name
- EARL-WILLIAM MICEY' . VJILMA MILEY - - - BUSING
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• DORIS MILEY "-i ;.::;;_-:.-- •f_:;`= WEE- _ 5534.EAST,550-SOUTH,FRANCISCO, IN 47649 - •' _ ,
n .. ._ . . . _-..[ - . 25 Rice Of D,pasam • - . . -
23e memo O10poYmr . 25n Place Of Daswostan [Nave Cr Cemetery.Crematory.Oma Rta) ' 25c Lamm-Ory.Toon.And Sam . . - O
(A m Baw.O CrerDolman esm O Dolman o,n
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_4 OReitre Finn Sme - - _ • 0•
W Dona(Sidra' - ALBRIGHT!CEMETERY _MACKEY,IN .n
26 Waspaoga Contacted, �2T.Wme and Cetpeie a,eNfl ce FUgnd Feb/ - - -_: -:-.r:`-,- - 27e Funnel Ione t,anse Nurser: _
"D rei m No'- CORN COLVIN FUNERAL HOME, INC.,323 N'MAIN ST: PO BOX'278 OAKLAND CITY, IN _ r
_ - " 47660-0278 '�:�= - - - •• ;, FH19400002 m
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' MARK R WALTER:BYYELECTRONIC SIGNATURE • IFD01013010 Ri
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- . Cause Of Death (See Instructions And Examples)
AterosVgb v
'I Sod, t I.Enter The.Chen Oratory ,•Diseases.Imures,Or Campnntinna-That Dkecne Caused The Death.Do Not Enter errotlEverts Intend Onset O
Suer As CadMmc Arrest,ResperatnylMest,Or VntroAar Frprilatcn Welnoul 9ramnp Tne Etbbgy Do Not Abbreviate.Enter Only One Cause On To Deam,
A Inn Add Am.^.wl Lanes IINe¢y dry
InreSite Cease Fi xi Disease Ortobiten Reautarg In Death) A ' PNEUMOMA - DAYS 1T•
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•_. Seaoermy lea Ca-dorms, II My.leading To The Cause Lrsea On B.' E COLT SEPTIC SHOCK •• DAYS Ter
Ire Enter The Underling Cause(inseam Or lryury That Intoted "•••••�•••. m
- Tne Events Resoling In Cleam)Last C CIRRHOSS - O
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= Pan It Era.GPe YTtcvlc&re, s 213 tab O. But Not Reeding In Tnelaynrytg Cause Gran M Pen I 79 NeS An Aatmsy°eNnea, o yes m No
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- - 30 Mere s'amosy F^Ong Amiable To Garotte The Cause 01 Dolls ❑Yes'DNo
31. Did Lm Use CR.hda t
- - 33 Manner a Oath -
. D`°p :.....••a••• D°•e••'r_.:r(..., D.. .. .u•s•..r..7o.:ems. ' m Nara.0 HPNme D Amaet D InmhOM re ..Prapasry O dce'm rrtw. Fends;
❑succeD cam Na Be Detmrmal
• 34 Geaaey ryIMaehlDayrcul - - 15 Tme01 ory 1 _. • 36 Raceakyury(EG.,Decoamfs HOme.CmsrWm sa Resarral Mbmn weal 37. easy At NAes2
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N lan.nOYsuy-.Smm- 38s, Sete/aMandl - -3&.Apt No 3M.ZO Cane y
m Onitie Haa•r]Qi1nan O.0 iraepalO trsury.�eae Gr.�...,r
• 41 SgLVe,Of Person Cetllarg Case Of Oven - - 42 Caner(Check Only One)
FRANCIS'D:•SHESHI:;BYELECTRONIC SIGNATURE '- m Cethng Rlratb, ❑claw ❑Heath Meer ""
43•NameAadressNU ZOCme 01 Penn Centyvg Cause a Deem -. • • • '4 Ucene Numb..- 45 Date Cents a.
v FRANCIS D?.SHESKI•;550.NORTKUNNERSITY BLVD,-INDIANAPOLIS,IN 46202 - . 01042361A • 11/012013
'46 mOVanI Finad Sennco P/pnda}•✓ - ' ' - -
47-'Ma's •
b Sgrmttee et LOW He.Inar ,. -: 49 For Registrar Only .Date Fred lMatHDeynenr ?'1
VIRGINIA A CAINE..VIA:ELECTRONIC SIGNATURE - • • "•• • - - NOV 07 2013 • ■ -
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) 21'
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h. ag o oc6- Soo - ooD. 511 001
4 'Sla4SamE33g5 ATTENTION ESTATE the Sams!Scurejera Way se:rested by Was state agency ut ads b, ewe respore{dry. Dsclmure is voluntary and the-e race be no Penally log refusal
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WARNtIdG ORIGINALDOCUMENT HAS A MUkTICOLORED BACKGROUND ON SPECIAL WHITE SECURITY PAPER AND THE GREAT SEAL OF THE STATE OF INDIANA ON BACK THAT set•
TURNS FROM ORANGE TO YELLOW WHEN RUBBED ORIGINAL DOCUMENT HAS HIDDEN VOID ON FRONT THAT APPEARS WHEN PHOTO COPIED
: .tr S,Kr ..4557. .. .rid"y:. "f.° . :.iz 21."`•'M` 5—D : ,r.STATEr OE"INDIANA- - Reg ,.=3. 's,_\= ../ _-'H :; •y cep J;r• . ;Fr