Loading...
Death Certificate - Williams, Manford L_1/20/2015 Uly_ lb • ATTEMiON ESTATE The SoTial Security I is :' a:I ' J>•# ' . e obyn °s>r' " u1D�n; INDIANA STATE.DEPARTMENPOF HEALTH= caalig(ad there wiT be no pens for refusal 21 LoxbNo R O I . D S CERTIFICATE"OF DEATH .State No :. i l -- ,THE RECORDS IN THIS SERIES ME CONFIDENfAL PER IC 1537 110 ' - _ i';- ,- - . . - GCCE.\YO—eIAK v.n WUa tV.l - _ O.s e s :Rao(KdiH_ ' m D TE OF DEALH 4b.ea < ( .D ▪yT ... Manford L Williams_.-. .+Male c.5:30 - •- m 1--(▪ Dry y T * 76 . . _ Auqust 7; 1928 Gwensv lie IN _ " O m Z 1. a.a SDP ;. m UYEAR�SE�O4 - 'L PLACE Of DEATH co.ca*NS oe:See aC ) - <z rR HOSRTAL ❑ ti ?oa ' - OTTER 'O tkirtn2 lfPn: ❑ill".($c... r =71. i. Yes . :1951 ❑-Eaq;L+ew.'D-oa If y n' _ a, r ct T1 NAME if K w,pia Onn n,., ac CITY.TOWN OR LOCATION OF DEATH• + 96 COUNTY Of DEATH - m N .415 S.:West St. . ,.err; -.�- .cam _; .r -a Haubstadt • Gibson • _coT : 10 MAH•AL STATUS SIRLT'NG SPOUSE' tP%y 1 DECEDENTSUSUALOCCWATON(G<1MM rse 125 (EC OF BUSNESSANIXSTRV p ?2 csi„,a),)i.l ; I.,/Nt nN.empnl ,T [' 7(T.eov uFro a/_pbUiu wlw t.ped)� ' ' .,G_ (-O O t, Norma Maie -IT r?eiK!3r _ - iCo-Owner . _, r RetafCtJqu❑r -\ 2 } 2pJU-:C TF . - • CRYkrOWM OP i IS 5/.21--M1 . .•O Q m x i. N ,_ ;#4_ o 1.Y Ofi s• S ' 49 -.-5 . ` 3 Gibsn - 4. :Haubsfadt-- {s 415 S West:St-...,-f. mrrn : 8 'CO n n m ( ,3. ZP CODE III NSDE CITY LNRS II CATIZENOF IS WAS OECEDEN3 OF I95PAt COrnGW )6 SACS -Aan.n,asset 1) DECADOA SEDUCAEn4 m0A ❑N Q-Yt . 3YMAi COU:TRY �3`N ❑v are ae/r C,Cn P.YC}.3va.ac (SPecly ph/w?�t DIEM<pear.Ea .ZS Z'-I ban Java'Pun Than etc/ rSU<M f1e. +mr/5ecawr ro.t2) CeleC<n 3.T _'� o> ,-r_476394(1 o ❑,L :' I : , , -- asr4 ut Whlce 1101572%7M <r.rz.�..••(Z A� '. 1e FADERS NAME(Fm Matt Lad I1•47. f'Y I9 MOTHERS N«.(Finlay.A<.cri Sorrel . .y >o O;t ■ ` . " Noel Williams � . r. ..-214.2:-.: . . • .Edna.Ranklns Ali > m-' - :5 Oi xi ISIORIANi S NAlE( )yf A.E . ',pi:MASPIG LGC(ESS(5Pt aM MAC.. MY NYt tM,0.-Cer v rw�t a-.ZO CoWI'• IOn HwevW • m>1 I -Norma Williams :; -..41.5,S:-.West St.Haubstadt,IN 47639 _ ( /Wife_ _ 0s-1• 2!E METHDDOF DISPOSITION'-17 E,meim<A - 2Ii DATE AND PI<CE OF DEPOSITION(Nei,.a<aw�y wenucry 21c LOCATION—C.y&,fa.n S t a g - ny: &i R a i 0 CnksPacet 0r.+t1>„sm. C.1 8r -. ;,Janilary 13. 2005 v-: =i D Oars. !s° '„ Sts Peter& P-aul.Cemetery '. _ Haubstatlt IN • 220 Et®ALA:ps ocENSE NO - . • 23 WasoEA TR REPORTED iOCCRONERTT y . Nn ."I-AlanJ-Wade y�FD01017080 " ".°_ OY __ , . . cn m i :Y SIGNATURE OF FUNERAL DIRECTOR - 30LICENSE MOUSE 'SNAI4DD9ssAND LICENSE LUMBER Of I ratinzky •-_ m �—' C1 tdlimo:1 - 4D. i_`wig. t m D '3` ar- ;p N Wade Funeral Horde Inc� s FH63002990 n'rt .. . t:- • 'Y.P )1:UU10]7080 P.O.Box 220 1199 South Vine St Haubstadt.JN - r• o°t' =e P.m, .. .. .. ._. Ur N Err.Y+ -'.P•p�II4 eC. r Im<a ae .� yak .emit.sock a<ne.r tit,.Lso osy ee c•ao coo Y _ w.r eu:M. _ /nom _.. r. 1 / :-R- �,N.� n -i y[ e w®IATE C.tUSE rinel e W<�'L'�./�(j,J�_FY� =�->L�� .+2..�. � anZ, awv °'a°' DU7-CDR A.SACOt SEOVENC.(OFi ,a . . •- .• __() Om m fir. oAw.,erF+l a .Vii.(TLTU�E(!i�i3_T iYw0-54:L -C -ems' el-CA«_- •��P ILS!J_� -T- nnr Caren.aan..inT ions col.. '3'_CT °. - _� n F. t cMm.<sa< E N/L EORAS 'E/L-ei.E _ _.GJ,e6,'1/J _ -"y > ' .my .1222 _DUE TO TOR∎S<CONSEQUENCE OFi .0: �i � ' Z '. Z t _rite e_ { ". _` 1 o Then ” PAST 0O�p IOMCMe cowso..Cact-us co'atap S bcl M na etvwIy ewes el 011 1 27 WAS DECEDINT 2e. WAS AN AUTOPSY 235 YSE AUTOPSY FINDINGS O 0'0. : : rr 0 DAYSU'E- i Ti. XCEP:EEA nn NGPHVSOAN T P NPd-r..'n.1edtso P /yera W CisPatrM Ox;t.c.uN(MUei.m. __• C ,==1. �[nr4 wy ❑.IE.LLTet OFFlLE9 Ont.Eaa N vaven &al eID9•m+awy coo.dm ecut.0 a w ems.era ens w ro m It to coats) u p RI m m k 0 coae t D. .e.4: .: w.ou: .e..-. .,:cure i .H.. ..s.) . em.e D© ' :R PRE OF CEATEE 29c MEDICAL IKENS!nb'- 79c LATE 5)(MD .0 t Day-V.. pmt- ! ^y� r�jT' =z-s. f _- '°^.1.�. v�.i, . __ __ 07024530. ./. -:<.`r� ..OS14:: : m- ' Ni.N<LE LND AOLYESS OF PERSON wHO COMP ETED CAUSE OF DEATH 0TEM 26f l Tistrar T 1 - ▪ >° Richard.Gfies M.O.-304 E Highway 68 Haubstadt,IN 47639 : ,. _ - ; _ 4th 3` r 31 HEALTH DIALERS SCNAR/IE 33 -A YE FLEO(MntiDo.I'M) B G / v :. gel"- .,s-P..L/1/1.2005 2-m -IY i a) YuA.W Or De.r,1 - 24. o/.rz OF JVP >.e ruF Oe . f. !V • ?MA? Lit (KVILIIF MIIw W.TY(Yn IRPfrI- . • (Abaco D.Y.Yea) V:ANY.'• • (Visa no) ' O• )0 Neva ❑P.:»ry ❑K<Wen 3t. RACE Of INAIRV Slay l Troy.cR NI LOCATION Soea aria Nwp..RaM Na.<Wont.-Cry..le.ni.SM.) I O._.Thud •• e . ❑ r at ' C ' jt0 DATE RUNOVNCED DEAD(Alan Day.Var) 3M MOTOR VouCU ACCCENT/(ve.v no) FYn.Pala SN.'ue..pr.paMU'.5 4R..• :r. - SDHOc-004 State Form 10110(R5/1-99) ,_... (5103) 1