Death Certificate - Yeager, George L_4/25/2013 MIkn TTmlTalrma>a.nr.4...........■.. 1 �� V
tt4D1Al E IA ST AS DEPARTMENT OF NEALSN
CERTIFICATE OF DEATH
,` 4th '� Local No 001821 1 ti EDR No 000000221203 - -' state No 042892
t 1.Cacnenes Legal Name(Fat Mee.Lest) r 1e. Madan Name N mr..m) I 2.s., 7 3. Ten.a neap, I a. U.S Of Darn(Yam n)am.ri
t
GEORGE LLOYD YEAGER - •• - '_ `t- t ! . MALE 01:58 PM 09/26/2011
93 molth, Dye • - Noun Mmuui 2..4.- 1.,I• 09/22/1918 STURGEON, IN
9 Ever nu S A•med Faust 10.V Dean Occurred In A noML' l0a a Dean Omme Swann Over Than A HO,pW
10 0 Yes ❑NO ❑Unknown ❑Inpatient ❑Emergency D.Patmu¢Oumniw ❑Dead on?Alegi 0 0".Se Fadiy ❑Decade rts Han ❑Nva p Kane anpm m Cam Fmk/
L�Dnr(sp..
It. Fee7.y Noma pt NCI Insmoon.Din Sae end Numbed -
DEACONESS HOSPICE CARE CENTER •
12. Cty Of TO.m Slam,And Zc Code r • • 13 County a Neel 1a UMW Snap Al Tom O1Deen
u. ] - _\ ��
❑ Karnes lay ❑Dworved
EVANSVILLE,IN,47747 VANDERBURGH B O.. ❑Unknown
15. Sunning Spouses Hama 15a (II WN)Gne Hoiden Lan Name '
1e Decedents Usual OrdupaaOn t1. And BuakciWduuy
SALES RESTAURANT
EQUIPMENT - - - BRUCKENS
1e. Residence•Stem tea. Covey 180. City Or To.n
INDIANA VANDERBURGH EVANSVILLE
tic Seat And Number - tad. Apt No. 1Se. Zo Cod. 151.knee Cy Lams?
-
3021 COMFORT COURT - 47720 CD Yes ❑tad
l9. Decmans Eduuwn 20. Decedent Ottawa"Orlon. 21. geudents Rau
SOME COLLEGE CREDIT, BUT NOT A 1 •
DEGREE NOT HISPANIC White
22.Faumr,Name(Fpsl Med.,Lug 23 Meter,Name(Fret*Mee Ln) Ada Mousers Mahn Last Hama
AUGUST YEAGER LULA YEAGER UNKNOWN
24.Interment,Nam. 244 R.seoontrop TO DauNM 24b.gasp Ad*..a(Stem And NmnNt.City.Sw,Zy Cede)
JAMES YEAGER SON - 1173 REGENCY COURT, EVANSVILLE,IN 47710
25 Piece a a,poeten
251.Method Of Cpdositon 250.Plea Of Dlsposnen(Name a Cemetery.Crematory,Other Piece) 25c.Imam-Cy,Town And Stela
0 Banal❑Cn raton ❑Donattn❑Emmental
❑Removal From State
❑caw (spacyy. ,ALEXANDER MEMORIAL PARK EVANSVILLE,IN
2e.Was Coroner CoNScted7 27.Name Are Complete Address OI Flmere Feelq 274. Fum.4 Name License Number.
❑Tea ®Nd ALEXANDER FUNERAL HOME,WEST CHAPEL,2100 W.ILLINOIS STREET, EVANSVILLE,
IN 47712 FH19900015 I
270 Sinatum Of Imdala Fuses Se7noe Licenser 27C.4c.nse Number(Or ucemee):
JEFFREY W.ALVEY, BY ELECTRONIC SIGNATURE FT/29600045
Cause Of Death (See Ineenictlan And Example') Aporxcnate
28 Pert I.Einar The snen Of Events .Diseases.!Judas,Or Complications-Thal Directly Caused The Death Do Not Enter Terminal Evens Interval: Onset
Such As Cardac Ni..!.Respiratory Arrest Or Ventricular Fbrillatron Wtoul Shoring The Etiology.Do Not Aedenate.Enter Only One Cause On To Death
A Line. Add Adatnal Lines II Necessary.
Immediate Cause(Final Oman Or Condtion Resoling In Death) A RESPIRATORY FAILURE DAYS
Pie•sa N,ones.00
Sequentially Lin Condtiont d Any,Leemrg To The Calve Listed On 8. CHRONIC OBSTRUCTIVE PULMONARY DISEASE YEARS
Lne A. Enter The Undmyig Clouse(Disease Or Ini,y Thal Inflated _ o""�"'�"°dd
The Events Resulig In Death)lost
C.
M1..N 4.,1w+04
D.
Penh Enter Oemr$ion:x tat Crd-sons COntnbuina w Death BA Not Resulting In TT*Underlying Cause G'vin In Pant 29.Was An ANaoey Penumedl
❑Ya ®HO
ATRIAL FIBRILLATION CORONARY ARTERY DISEASE FRAILTY,ANEMIA
30.Wen ALcopfy Front Analaf•To Candle.The Cause Or Des?7 ❑Y es ❑No
31. Did Taoacev VU COnnO.e To Dents 32. II Femele: 33 Moan Of Deavo
❑tone.+.•ve•rrrw• ❑A.er.ru rw a ewe ❑na Minas IPA ny.. AZ car yo-. El Natural❑nonacid* ❑Audn ❑Papnglnvesegabn❑Yee ❑propspy 1:31 NO ❑Unknown
❑woewe•. ,M.'M^.0 oT 71 l 7.4r'Die ❑Wm.I M1µ-W>r rM rww, i❑Skid,❑CCJd Na Be Determent
34. Date Or IrlUy luavYWy7Year) 35. Trio a lre,ny TO Plea a Iran(EO..Decedents Hone Corueuczn Sty,Rosman(Woad Mel 37.Irray At MVO
❑Yes ❑No
sa lontm Of Inuy-SUm 35..Cy Or Town Sae. Sawa Num ear 13ac Apt Na let. Zo Coda
33. Desoto Now instal 0=03 ' 40 II Tran,pateon In ty,cam. y•
1. Srymaae, Of Prams Crtrnc Cause Of Otar 42.cenlar (Check toy One)
DOUGLAS JAYE HAILER,BY ELECTRONIC SIGNATURE E amyilp Pnyaeen ❑Coroner ❑Ham O,aet
43 Name,Adaea,AM 2.0 Cent Of Person Ceitryly Cause Of Dean 44. tang Niatee 45.Dam Cer-bed
DOUGLAS JAYE HAILER ,4498 FIRST AVENUE, EVANSVILLE,IN 47710 01039937A 10/02/2011
at Adltonm FOroN Service Provider. 47. 'Ana
45. Siputure of Local Hum 015ur. 40 For R.prnr Only -Dam Had(Y
onNDaylYV):
RAYMOND W. NICHOLSON,JR., VIA ELECTRONIC SIGNATURE OCT 03 2011
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
State Fain 5 1VS A.ATTENTION ESTATE:The Sacral S.aaty a Is being requested by this slate agency n order to pursue rapdnaelty. Disclosure c voknisry end hero will be no peaty to refusal
(7/05)
VOID IF ALTERED OR ERASED-NOT VALID N.. e a : . : I. I •. . ,a