Death Certificate - Yockey, Leola Aa_7/30/2014 • -- -. • -=- -- -'- A., . _ _.._. .
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*ATTENTION ESTATE:Tne Social Sect ‘itii ity 4 is .i. so, Ice Co
being requested.by this state agency in order to
tee-rth_nitt II,statutory responsibility. Diedosple is INDIANA STATE DEPARTMENT OF HEALTH
-,a arm Mere v.41 be no penalty lor reuse].
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Local No. /--- 1/ ' (i "7
----• , • CERTIFICATE OF DEATH State No.
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THE RECORDS IN THIS SERIES ARE CONFIDENTIAL PER IC 16-37-1-10
_ I DECFAccH-PALE Gust,sat.Lzsrl 2. X Za mu OF DEATH at DATE OF DE.ATH worst 04y.2 0
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Leola A Yockey Female 5:41 PM June 3, 2007
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84 ctober 16,1922 West Salem, Illinois
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IF vLIC LOOT cccIr--n..1 PLACE OF DEATH (Che.i.ally one Se ost-Lc&P;)
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c River Oaks Princeton C.-OnAnn
Ft z -C lo.cutout STATUS I-.1.SURVIVING SPOUSE 122.DECEDENTS USUAL CCCUPATION(GAY int 01'1174 129.rUUD OF euscassetousint
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ri 0 0 Prole (relc. .6,.raskien nye) Cale Arm flee vricstm, Do ns we rezn-C 1
-- '.. Married !Joseph Louis lackey Housewife Domestic
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Indiana 'Gibson Princeton 213 Vermont
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m m 17 i/SHERD HALE in-A Vent r_aS) 19 Mc THSRS NAME (7.:S.Atbait//en&Ann)
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r -4 0:-1. John Myers Bessie Mckinzie
5. --1,‘ "M :cc. pitt00t.trinft.u4 1624-4,..4 700-HALING/coats acre row moue,w Ant aaa.Mov.et,4g 4'T454 474,4.SP Oak) 7Cct RLHONFounD
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r- Joseph Louis Yockey 213 Vermont Princeton, IN 47670- Husband
o; 2'a METHOO Cf DISPOSITION 0 emit, 'It.DATE AND PLACE OF CaSPOSITION(T.Sfne of carales.c-cznatcry.44 .21c LOCATION-Car or Tc-nn.Ste.
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0 Data 0 Other orwi*, Walnut Hill Cemetery Fort Branch, Indiana
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I-cs 20.0 SIGNATIME ma)MLE OF MESSIER alfeinbatlijc..V\ , i n 25c LEDISAL LICENSE NO. . c 3 09-)F SIGNED!Fatly,r...",.Yoal
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7■ -0 o Dr. Ramesh P Patel, M.D. .' ' -
e• >C 105 N. 2nd Ave. , Princeton, IN 47670
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MT DATE PRONOUNCED DEAD IMartt Day,Yr.-al 1113.MOTOR VSIICLE ACCOENT, ;Yes et At1 It yes spa*enter,pastsiger.sede=sin etc
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... SDI106-004 State Form 10110 (R5/1-99)
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GIBBON cOUMTY AUMTOR
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