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Death Certificate - Parker, Don E_11/6/2014
i, eiss-. )..- „,,,,, -,. r.: " 's - IND1ANA-S - I • - ' ' ' • 44EAt117- " ' -!7M9.,- dERtIFICATEOP bEAtl-i t it i- „ -;• , ,.. :. 1 • ;', : .: :•• 1 ;, 1.-; 8 rt ). ! S;, 1 Z 1 I ''; 1" ,, = !....1 ?.\it. 41 ;" y..- = c ' ' : • : 3 Local No 000231 '.>*-,,,Eb'''R"".N. o...0...-0'000 0 4. 1' 3 0'05'\ -,;';' S-:si_' te Ni'o; 0- 4'9 2- • \ ' 1 '; • • .1.Decederts Legal Nape CraLY-18.158.1-431,1"'''' , t- -'''. , •. 7' 1...,1a../taklenNarne'Of fenutle),,„„: ,.„, . r2 Sex, i."8, 3, /ime Of Death, ,•• 4 Der Of Death:pore ,.,,- .....„, ,.. ,. ,,..... ,,,, (...., 4.,,,,. 4.,„1)-,_, ;24'4 ,,:,./1 - rt .:“...„ ,,11!-.. ,,,..4:., .1-1,‘ ec., - :8 DONE PARKER.‘1,-; ±../ ••'-•i.k 2 2 2 i.2-: •-•=n1/4-,...'2. A .:tf .^.."'N 4...; ..; .,•''''‘ k't,ft.4ALI- •-•=264:45 Km :-.-: L.- c „,---icirs-ipoiir ^f, Armed Forces? 10.11 Deals Oconee In A Hospeat '.. ' A1 i. 1 " iCia. If Deam Occurred Somewhere Creser Than A Hospital.. 4, ,• 1,. ''•,' ,i ,,, ';; 1•,.,--y .. . .1: ,-c1Cf, ;;t•,.; 0 1148ce Faci{ly 0 Deed eriti Home' '0.Nursing Hcene?Lorig.tems Care Faulty 0 0 Yes 0 No 0 Unknown 0 lgolitent 0 Ernargeocr 6eoarm,n1-15,1fr.el, p Dead e ut,17 0^&11!'.8,1 ;0 Oyler(SpiecCy)l. rf ,. ••., 4 I It Factty Name(II Not Instaton,Give Street and Number) '1 524 SOUTH GIBSON STREET . : - ; : . • • 12.Oty Or Towr.Stra,And Z±p Code - 1 ' r 13;County Of Death 7 , : • I0 marned 0 Married,But Separated 0 04orced . . • „ PRINCETON,IN 47670 : • , 7 -,.. „.. GIBSON . : • ,.... , 0 Widowed.. 0 Neveryarned 0 Unknewn • 15.Saviving Spouses Name 15e Of Wha)GiveNtaiden Last Name ' ; .•• 16. Decedents Usual Occuprr ' ;17.-Kind Cl BusinessAniusty„ . , . 1 PETROLEUM -I• SUE ELLEN PARKER CARNAH ,AN ' : • . C 2 - PIPELINE OPERATOR ': PRODUCTION • '; " 18.Resicerce-State . 18a Carey . ; ' ,,/ laq Cony Or Town ..,. , . .. , • INDIANA • GIBSON • - - • . ..• •-.. PRINCETON .2. • - • • " • - -. 18c. Sleet And Number . , 18d. Apt No lac Zip Code . 181. Inside CAy Lanes? ,. . . . . " 524 SOUTH GIBSON STREET 0 YeS 0 No- 47670, . 1,, 19 Decedents Eds.craon 20. Decedent Of 114panic Ong8n I ,, -• "21!Decedent's Race , • - HIGH SCHOOL GRADUATE OR GED . • • . " • j COMPLETED ' NOT HISPANIC 2 • -. .• - 2... White . • • - 22 5411ePS Name(Fest Wide LAM) ' ' i : //' 23.Mallets Name(First.Wide,Last) 23a Mono's Maiden LastName P.. : " ' ; • • . :,', :: ' . EDMOND O. PARKER . . 2 = HELEN L! PARKER • LOVELESS $ 24.inharmant's Name ' 24a Relatmsnis To Decedent .., ,. 243.Mating Address (Street And Nutter,Cary,State,Zip Code) • • SUE E PARKER • - VVIFE, ... :• •• -- - 524 SOUTH GIBSON STREET, PRINCETON, IN 47670: .. . • .-.. • . , ,, -=,-• =2 25.Placibl DiSPPiiPa; ; :. ' • ' 25a MetAad Of 5155p0SeaOn • 25a Race Of Disposiecn'(Name Of Cemetery,Crematory.Oiler Place) ; 25c.Locator-Cay,Town,And State ' 0 Bui-al 0 Cameo= 0 Docabon 0 Entombment , • 0 Removal From Sate . ,. •' , . • . , . . -- . 0 03w(Specify): , • COLUMBIA WHITE CHURCH CEMETERY..•' PRINCETON, IN • 25.111as Comer Contacted? 27. Name And Complete Address Of Funeral Fealty / ;•r 27a. Funeral Hors License Number_ .. . .i' ' ' • : ;.. , ' : %. , ' 0 Yes 0 No COLVIN FUNERAL HOME INC 425N MAIN•ST., PRINCETON, IN 47670 . . :. FH83005671 2 . 27e Signataa Of Indiana Funeral Service Licensee: • 27c. license Nanher(Of Licensee): : RICHARD DEAN HICKROD, BY ELECTRONIC SIGNATURE .i 2,..,- ' • •• - ' .2 -.. FD01012153 • . . . • • , Cause Of Death (See Instructions And Examples) Approximate' 23.Part I.Enter The Chal Events -Diseases,triunes,Or Ccomlicatiiiis-ThaiDirectly Caused The Mirth.Do Net Enter Terminal Events . Such As Cardiac Arrest,Respiratory Arrest,Or Vertnoular Fibrillation Wthout Showing The Etiology.Do Not Abbreviate:Enter Only One Cause On To Deets . A Line Add Addlinal Lines If Necessary. : . ' ' s' 1".• f .". - ' • . . . . . lownediate Cause(Final Disease Or Conniton Resulting In Death) A ACUTE.NWOCARDLAL INFARCTION• - . . . . I HOUR • . 5, s . . • B. DYSRHYTEMIA .•' ' , 1 HOUR ' ( Sequentially List Condibans, It Any,Leadng To The Cause Listed en • Line A. Enter The Underlying Cause(Disease Or Injury That Initiated • -- A' ,. • , • . :-' The Events Resulting In Death)Last , ' , ' 1 HOUR .," . Daerc.4.4 cwee......co , . . , • . ; i :, ; • . ; i . - , D: HYPERTBNSION r- ! t . t . : ' . SEVERN,YEARS Pal a Emer omer B±gentcartnrAting mSk.am But Not Resulteg In The Underlying Cause Givih In Part I . 29.Was An Macon Performed? '..0 Yes 0 no ,, : : -.' • • DIABETES MELLITUS , ._ ,. •.:..,. ,.. ; . 2-- sos,were AdtOpSy finding Avadabla To Complete The Cause Of Death? 9 Yes 0 - ' -.< 31. CM Tobacco Use Consimne To Dern? 32. II Fernet 33.Merrier OfDeatn:- ' . . -. % .. 0 ea`11.own'a,1 P.eur ntr 0 eirere se di Own b Aiki4.544i g.it PAKAiii vain 42 04Ti012.45, 0 Neural 0 HCCSOCO 0 Acitident 0 i'en4109 1,841114mPa° 0 Yes 0 PrObabiy 0 No 10 Unknown 0 Nctc.n..,........nno 001e•T.,Boa.0445, 0%Ain..if A4pAnt W054 The N.vai 0 Saidde 0 calm Nil Be Determiner, ,. : • • : • 34.ors Cr injury(1Acern/Dayttear) 35. Tame Of Injury • ' : 36, Place Of Mary(EC.,Decedents Home,ponstrucoon Site,Restaurant VVccded Area)I .37..Inpay At Work? , '..1 • „. - . ,0 Yes , Otto . • ., .. ., . .„. . . • . , 38.LOCat011(31 triply•&a's . 38a. Cay Or Tom; . ' it 383. Street 8 Natter . • 38c. Apt No. - .384 3p Code . , ....• . . • • , . , 39,'Descnte How Oren/°cam ' /-eo • ' 40 It Transportation Inasy, reoify: • .' . . 0044/10en. 01.84A4At 04.444.,'00.."VA4444 . ...• -. / • . . • 41. Signature, Of Person Certfying Cause 01 Death. . '" 42.Cert5er(Check Only Cre), ; . • BRUCE CARLTON BRINK JR , BY ELECTRONIC SIGNATURE! . '"\ . 2 - .• - 0 cerarng prtisictan = 0 Cdroner, 0 Heath .081cer.' . 43.Name,Address AM Zip Code Of Person Certtying Cause at Death: ' 44. 1..1010341 Hunter 45. Date stied . • . . BRUCE CARLTON BRINK JR ,410 NORTH MAIN-STREET, PRINCETON,IN 47670 . . 02060616A , . • . . . . 11/03/2014 2 .5. Its A= Onall Funeral Ser4Ce Prodder. , - . - i- I 48. Signature of Local Heath 015cer., - N.. : BRUCE BRINK JR:N/lA ELECTRONIC SIGNATURE .I s ; ; C. '.i I I .:. k .. . ..- i '.. . -.NOV 03 2014 ", 1, i AMENDMENT 113 CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) Y t t i < : Z.' .1' 3 y t, t T: : 3 3 i • '' ',,,, , ..:53::::, -t- • - 33t, ? 2" ' % i'", % ',/ ... ''''' ' ''' 'T- -1 -'..: ,,. -- - ' ;, :- -:. -.-- ' -s. -.-- --.. I ".., :,-% 4.- .i ., '‘. c :,./ c., .' ----',, ,i t (, r .. ., : i ;.; :- ,,.:•.- -.., 3., , : : : , r F . . E, i " i- ?. :.. -“: ' ", `, ,-... :.-- .t. . :.s : .• '.- ., - : , , ., -.• .., 1 -.StriteFor.r.h 53395 ATTEriTION ESTATE:TheScaal Security 0 is being requicidby this State agency in drder,to,,pursuerespcosttpy4 DiscloT.ute IS voluniary ant/there'veitlisknonenattmccrelusais F. ,.. .: \-..4 1 AR*11Na" oliGlitAl:DOCUMENT 1-tAS A MULTICOLORED BACKGROUND OM 0E*LitiMITe SECURITY F1'AISIR-AND THE GREAT SEAL Elf THE STATE-Of MOGUL.ON BAal<IRA T-tl ...TURNS FROM ORANGE TO YELLOW WHEN RUBBED!ORIGINAL DOCUMENT HAS HIDDEN VOID ON FRONT THAT APPEARS WHEN PHOTO COPIED,'" "r,.