Death Certificate - Engler, Norma J_3/19/2015 ia'"4 /" INDIANA'STATE DE RTMENT'OFHEALTH` ,
e CERTIFICATE OF DEATH
.�% Local No 00121 EDR N6:000000435743--- state No 010480`' '' L /_'
I1 Decedents leg al Name(FirsCM1WGle,Last) , tb'^ sa Malden Name(I(fela'e) i<S 2 Sea, 3 Time Of Deaf' fery, 4.DYte Of De atc(MheVDay/Year
.. .' _ v i
g NORMA JEAN ENGLER. '` `, `' KOHLMEYER : 3 -‘` 'FEMALE 1 02:56 PM ' : •03/02/2015 • -
_ 89 Moon ''! Days ,! I Hours . _ ¬es! \,,,- 11/27/1925 L. .:" 'ELBERFELD,`IN .../
` 'B Ever n U.S:Armed Forces 10.1f Death Ocarred In A Hospital , 103 U Dean Oaurred Somewhre Other Than A Hospital
! " - , - ' -` D Hospice Fatty _.D Decedrrs Home '0 Nursing Homeilong-tenn Care Faulty is, ❑Yes ®No...0 Untnovm 0Inpa.ens 0 Emergency Depament Ougasent,0 De d on Anal ,0, Omer(apeay); ,"
E■ It.Fatly Name(It Not Ins'Watson,Give Street and Number) ,
DEACONESS GATEWAY . , _
12.'CM Or Town,Sate.And Zip Code 13.,County Of Death , 14. Mental Sams At TUre Of Death
. ' 0 Marred 0 Married,But Separated 0 Divrceo
NEWBURGH,IN, 47630 / r - _ WARRICK ' ®widowed ❑New Married DUnknown
15.SuMVing Spouses Name , I5a.(If Wde)GNe Malden Last Name' .•• 15. Decedents Usual Occupa5m 17. Kind Of Business/Industry'
' i ; i '. SECRETARY EDUCATION _
• 16. Residence-Sate Ida..Crony .,' 160.Cy Town ,
INDIANA GIBBON .
• - . PRINCETON•''
IBC Street And Number - ' - ' ' ' 164:Apt.No. IBe. Zip Code 18f. Inside City Lien's? '
®yes 0 No
1800%A/EST BUP..LINGTON PLACE • _ , . _ 47670 .
19.Decedents Ean ' , 20.Decedent 0l Hispanic angel 21. Decedents Race
SOME COLLEGE CREDIT; BUT NOT A DEGREE NOT HISPANIC ''�, White' .22.Fathers Name(First,kkddle.Last) - ' -• 21!.loners Name(First.Middle,Last) 23a.Mothers Maiden Last Name•
, ELI KOHLMEYER • • BERTHA KOHLMEYER LIBBERT
24.Lffornanrs Name • 24a.Relatonshp To Decedent"-' '" 240.Mating Address'(Street And Number.City.State.Zip Code)
STEPHEN ENGLER SON . . - Z. 9822.EAST COOPERS HAWK'DRIVE, SUN LAKES,AZ 85248
. ' 4 t 25.Flace Of Dispositon
25a,Medlod Of Disposition 250.Place Of Disposition(Name Of Cemetery.Crematory.Other Place) 25c.Location--City.Town,And State
. El Bunai 0 Cremation 0 Donation 0 Entombment ' :', t
' D Removal From State - '�
D DNer(Specify ' WALNUT HILL CEMETERY . FORT BRANCH, IN
26.Was Coroner Congaed? - 27. Name And Complete Address Of Funeral Facery .' - . 27a. Funeral Holm License Number
❑Yes 0 N . COLVIN FUNERAL HOME INC, 425 N MAIN ST., PRINCETON, IN 47670 FH83005671 • ,
275. Signature Of Indiana Funeral Service Licensee: 27c.License Hurterlm LOenseek -
JOHN W WELLS , BY ELECTRONIC SIGNATURE .-!' . . • . : FD01009940 •
Cause Of Death (See Instructions And Examples) Approximate. '
28.Part I.Enter The O, in O1 Events -Diseases,Injuries,Or CanpUcatiani-That Oireoly Caused The Death.Do NW Enter Terminal Events Interval: Onset
Such As Cardiac Arrest,Respiratory Arrest.Or Ventnwlar Fibrillation Without Showing The Etiology.'Do Not Abbreviate.Enter Onty One Cause On To Death '
A Line. Add Additinal lines If Necessary.
'Immediate Cause(Final Disease Or Condition Resulting In Death) A. CARDIAC ARREST - t ' - HOURS
• p..t&e..w..,..OO
Seauentiaiy List Conditions. If My,Leading To The Cause listed On B. ACUTE RESPIRATORY FAILURE ' +, HOURS • - "
D.......(0.•.•c2,...........CO
Line A. Enter The Undedying Cause(Disease Or Injury That Initiated
•The Events Resulting In Death)Last C.. HOSPITAL ACQUIRED PNEUMONIA ~ DAYS -
• .11 'ACUTE RENAL FAILURE MOST LIKELY RELATED TO CARDIAC ARREST AND HYPOTENSION . HOURS "
Pan IL Enter OtherSOnScant f.rnmtkns Contbupno to Dealt But Not Resulting th The Underlying Cause Givin In Pan) '28 Was.M Aotimsy Prfom,ed? D Yes 0 N _
- ACUTE METABOLIC ACIDOSIS.SEVERE AORTIC STENOS'S,CORONARY ARiinf DISEASE,SYSTOLIC TYPE- 30.Weree Autopsy F'nprg Avaeable To Complex The Cause Of Dean?
CONGESTIVE HEART FAILURE,CHRONIC KIDNEY FAILURE , - ,. \ - _ D Yes D No
31. Did Tobacoo Use Contribute To Death? 32.If Female; i t 33. Manner Of Dear:
Dh" "r' we.;es.me, ❑A.err.na ln..ow...'.D'n. .r..-earv.>...,wen.,.:onwo... 0 Natural DHomicide DAccident D Pending Invesigatdn
D Yes 0 Probedy D No O Unknown
Ot.,n.r:+deetrs"n Dan::,err e.e'.p:... ,,Du.,.�e!w wwee;m.e..'.a, . 0 Suicide 0 Could Not Be Determined
' 34. Date Of Injury(MOnbvDaylYer) 35, Tine Of Injury - t 36. Pace Of Injury(E.G.'Decedent's Home.Construction She.Restaurant.Wooded Area) 37.Injury At Work?
• DYes DNo
38.Locton Oflryury-Slate 38a.City O<TOwn, -380.Street 8NUmbr - 38c. Apt No. 38c.Zip Code
•
' 39.Describe How Injury Occurred '" 40 If Transportation injury, afy. '
/' ,,, ., �.. D>....a..w De.. ..-n OD..ae.>,l . .
41.Sg am e.Of Person Crtiytg Cause Of Dean: - 42.Cutter(Coed ONy One)
EMANUELA DIDITA, BY ELECTRONIC SIGNATURE . _ .. . _ O Certifying Physician D Caonr . D Head,Otcer .
43. Name,Address And Zip Code Of Person Certfyug Cause Of Death: ' 44.License Mender 45. Data Certfed
EMANUELA DIDITA ,600 MARY STREET,•EVANSVILLE, IN 47747- . • •. .t . 01071954A 03/03/2015
46. Additional Funeral Service Provider 47.'Alias:
• 48.Sgasire of Local Heal,.OCter 49 For Registrar Only -Date Feed (MonWDaylYearr
't RICKY B YEAGER,,VIA ELECTRONICSIGNATURE iii t:- > . '. :MAR 042015
i. > •, , _ . , •. v.AMENDMENT TO CERTIFICATE OF DEATH(ENTRY ORORIGINAL)1 ; ! .
>a . -x: .
t. State Form:83795 ATTENTION ESTATE The Soda)Secvrty a is berg regues ed by this state agency in'ordevto pursue responsibitty,;D,sclosure is vol ntary and there will be no penally for iN.usal- ' •
'........WARNING._ORIGINAL'DOCUMENT HIS A MULTICOLORED BACKGROUND ON SPECLAL WHITE SECURITVPAT ER AND THE GREAT SEAL OF THE STATE OF IND ANA ON BACK THAT'`
. TURNS FROM ORANGE TO YELLOWWHEN RUBBED=ORIGINAL DOCUMENT HAS HIDDEN VOIDON FRONT THAT.APPEARS WHEN PHOTO COPIED' •,.,,,r