Death Certificate - Algier, Larry_10/15/2014 ISSUED BY MARION COUNTY PUBLIC HEALTH DEPARTMENT
-" INDIANA STATE DEPARTMENT OF HEALTH
( n1' ; CERTIFICATE OF DEATH .
'� % Local No 005439 EDR No 000000332918 State No
:.De(re'as legal Name(First,'Scale.Lag) 1a Maces Nam(II female) 2.Sea 3. Tithe Of Death 4. Dos a Dem(MO1OYaynes)
LARRY J ALGAIER MALE 01:25 PM 07/09/2013
Hospital
0 Yes 0 No ❑U:%norm trpebmt (]Emergency 0 N ed a Fealty 0 Decedents Nme 0 M14sng Hanetongsem Care Faciy
gency Deparonent Oubeta.: 0 Deed a Amrel 0 Other(SpeoN)
11. Fectty Name(II Het bF-Moor,ave Street and Nunes)
IU HEALTH METHODIST HOSPITAL
12 City Or Tann.State.And Fro Code 13 Canny Of Deans 14 Maul Status At Tine05een
0 Maned 0 Mamed.Eta Separated 0 Divorced
INDIANAPOLIS. IN. 46202 MARION 0 Wwpwea 0 Newer Mwned 0 Urisawn
15. Survhing$cause's Nance 15a.(II tike,Give Maice',tee Niue IS. Decedents usual Omrpeson 17. Kw GI BvanessLalsay
SANDRA ALGAIER WALL MANAGEMENT GRAIN ELEVATOR
13. Res[nce-Sate Ida. Canty I®.ay Or Town
INDIANA GIBSON FORT BRANCH
Is.. Steel And Number 18d.Apt.No. 1de. Lp Code 1E.Inset<City tarts?
8167 SOUTH ANGELIA DRIVE 47648 0 Yes 0 No
:9. De-scar/5 Eduction M. Decedent 01 NscarvC Ongn 21. Decedent's Race
ASSOCIATE DEGREE (AA.AS) NOT HISPANIC White
22 Fetters Mama(Fuse,Lc8e.last) 23.Mothers Narne(FT-at MAdle,Last) 23a.MOthniMNen Last:tame
WILLIAM J.ALGAIER CLARA ALGAIER NORDHAUS
24 In o-manrs Name 24a Raasa:snip To Dececnt 249 Matrg Address(Street MC Wrote.Ott State.Zip Code)
SANDRA ALGAIER WIFE 18167 SOUTH ANGELIA DRIVE, FORT BRANCH, IN 47648 ^
I 25.Place a Dimos non
25a.Mee-L Of Daatia 259 Place a Dspossa(Name Of Cemetery.Cron boric Other Race) 25c.LocaSen-Dry,Town,AM Slate
0 Buena' 0 Cremator. 0 Denton 0 Enmrroment
0 Removal From Sate
0 Other(SpePtyt ALEXANDER MEMORIAL PARK EVANSVILLE. IN
25'Flat Cana Cmacec? 27. Name And Complete Actress Cl FUrea Facility 27a.Funeral Hume License tastier:
❑Yes 0 No ALEXANDER FUNERAL HOME, EAST CHAPEL, 2115 LINCOLN AVENUE,EVANSVILLE,IN
47714 FH19900014
T.Sytasre Cl Inder.e Fut-era Service Licensee 27: License Number(a licensee):
DONALD N/SIMPSON , BY ELECTRONIC SIGNATURE FD01001154
Cause Of Death (See Instructions And Examples) Approximate
23.Par 7 Enter The Chain 01 Events -Diseases,Injuries,Or Completions-That Directly Caused The Death.Do Not Enter Terminal Events Interval: Onset
Such As Cardiac Arrest,Respiratory Arrest Or Ventrctiar Fibrillation N.'ehou:Stowing The Etiobgy.Do Net Abbreviate.Enter Only One Cause On r . To Death
A Line. Add Addtnal Lines It Necessary.
Immediate Cause(Final Disease Or Gond:bon Resul ng In Death) A SEPSIS SECONDARY TO ENDOCARDITIS I V,EET<
a eta..A.:a.w....Co
Sequertialy List CoM9ons, It Any,Leading To The Cause Listed On B
Line A. Enter The Uecerhtog Cause(Disease Or Injury That Imta:m oaala...vww.a.w.us
The Events Resueing In Death)last C.
i.e la u A ungw.Ott
D.
Pat II.Enter Omer sioruscart rptcPas Camwttno to Death But Not Restng N The underlying Cause Grnn In Pan I 29 Was M AUtWsy Pe:nueec7 0 Yes El No
KIDNEY CANCER.RENAL INSUFFICIENCY 30.Were AUtoosy FUtdng Aratable To Carrpiele The Cause a Deans? DYas 0 N
31. Da Tocacoo Use CaTbue To Dean? 32 Il Female: 33. Manner a Demo
❑Yes 0 Prcdaby❑No ❑UnRrcv.n 0.0 e..r. a,Gae... 01,9w..t...ar.o. 0...P.R..saer.rr,wA.w42D.w Orc..e- 0 Nattna D H roue 0 Acodenl 0 Pawrg lnvestga:a
D sea ery444.flun.p,..eioea ret rw ans.more, 0 sww..isenna win.Try Pall at if 0 Suicide 0 Cold Na Bete:emined
34 Date Of Inlay(Maljiky/Yeer) ' 135 fume CI lrwie 36. Race Of injury(E.G..Decedents Nome,Cassuna Ste,Resmrart,Wooded Neal 37. friary A1WaYI
D Yes 0 NP
33 location a Lnpry-State 35a. Oy Or Town 380. Steel 5 Number 33c.Apt No. 381 Zb Code
39 Des. Hex h-9ry Gemmed O It T2115paatton ,ry. ao,1,4.Door..t
a se.drt
41. Signature,01Perseetlry a tg Case Death: 42. Cerlaer(Check Only One) LJ
DAVID ANDREW HORMUTH , BY ELECTRONIC SIGNATURE G Certying Physdn 0 Lawler 0 Heathakke
43 tame,Address And Lp Cade OI Person Certtng Cause Of Dean: 44 license Murrtoa 45 Date Celled
DAVID ANDREW HORMUTH , 1801 N SENATE STE 755.INDIANAPOLIS, IN 46202 01032803A 07/192013
- 145 Mutual Fmerat Service Provide 47. 'Alas
43. Signe:se of local Hedst OC¢er. 49 For Registrar Only -Date Feed(McetMbyntearl:
'VIRGINIAA CAINE.VIA ELECTRONIC SIGNATURE JUL 26 2013
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
Sat lam 53395 ATTENTION ESTATE:Toe Social Security a is being requested by this state agency in order to pursue responvbilty, Disclosure is voluntary and there will be no penalty for refusal.