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Death Certificate - Hoke, Carolyn Sue_4/22/2015 ..w=Jr u::'•Y�•.c•-:. icy -� r, V::.-�... 2:1 YL .�F.:..:V_4 yM. W. /%..:..1-a-,;;y..VG.'9 .W..WL. c!-f--•:.:?-..e-_U' i:1 JY.'I11-c'...,.'E-a.. t C;7 .."...,.:,::,j.;i-,....� 1 CERTIFICATE OF DEATH'e �,.: -local'No 000198- ...EDR No 000000405567 ' state No 042893 f 1:Decedents legal Name(Frst„MtlCle las)^, N..,. '_.. .! .,1a MailenNanre(llfenak) "„u 7 Sex 3 Time Of Dear A'Dete PDeaVr:IM € CAROLYN SUE HOKE .a .- ' LYNCH.- t i ,- FEMALE ..-.04:53 AM i i' , 09/12/2014 - 1l : . 60' ' Mort Dan 7 Han- 7 e Mjsns T. \ A Hospital ❑Hospice Perky ❑Decedent's Hare - ❑Nursing HomeM1m¢teml Care Fealty ❑Yes 0 No ❑Unknown 0 Ipaluem ❑Emergency Department WyaMnt Dead on A,vat � p,a p,i .D ( y) - - i 11:Fatty Name(1t Not lnstdr m,Gave Street arid Mandel) - - : GIBSON GENERAL HOSPITAL • f 1.12:Cry P Town,Sias,And Lp Code 13.Canty Of Death 14.Marta Stmmu At Tine Of Dead ®Married❑Maned,&t Separated ❑Denstea PRINCETON, IN,47670 GIBSON ❑Widowed ❑NeverManied .❑Unknown 15 Saliva.Spouse's Name 15a. (If VNe)Give Maiden Last Name 16. Decedents Usual O¢Wabon 17. Kvtl P Business/Industry • DONALD HOKE HOMEMAKER OWN HOME e 18%Residence-State 18a. County i Leo, CM Or Toem INDIANA GIBSON . _ PRINCETON -. • 19c.Street AM Nurtlter .. 16o. Apt No. tee. Zip Code 18f. Itaude Coy Lards? 722 SOUTH STORMONT STREET 47670 ®Yes ❑No .19.Decedents Edi,raoon 20. Decedent Of Hispanic Ongn 21. Decedents Rau' . SOME COLLEGE CREDIT, BUT NOT A : DEGREE NOT HISPANIC - I White : • V.Fathers Name(First Mode,Last) 21.mothers Name(First,Mode,Last) 23a,Mothers Meoen Last Name f F CHARLES EDGAR LYNCH - HELEN FAYE.LYNCH DELONG '24.IrMnanes Name 24a.Relationship To Decedent 24b.Mang Adtrass(SteetAM Ntrtlter,City,SWe,LC Code) ,• - DONALD HOKE HUSBAND " 722 SOUTH STORMONT STREET, PRINCETON. IN 47670 25,Place Of Dispisrwn . • 25e.Method Of Psposnon Z50 Place Of Dispostbon(Name Of Cemetery,Crematory,Other Place) 25c.Locator'.City,Town,AM State ®&cal ❑Crematon 0 Domain❑Entombment .❑Removal From State I ❑Other(Spear: COLUMBIA WHITE CHURCH CEMETERY PRINCETON. IN -28.Was Corona Contacted?_ 27. Name And Complete Address 01 FuteM Faotly 27a Funeral Mn License Number. 0 Yes ❑No I DOYLE FUNERAL HOME, 520 S MAIN ST, PRINCETON, IN 47670 FH10400010 I275. Signature Of Indiana Fulcra'Service Licensee. 27c. License Number(01 Licensee): BARRETT W. DOYLE, BY ELECTRONIC SIGNATURE FD29500009 Cause Of Death (See Instructions And Examples) Aporoxvnate 28.Pan I.Enter The Cnain Of Events -Diseases,4ytnies,Or Complications-That Directly Caused The Death_Do Not Enter Terminal Events Interval: Onset Stroll As Cardiac Arrest,Respiratory Arrest,Or Ventncular Flbnlation Wthont Stvwvg The Etiology.Do Not Ahbrevate.Enter Only One Cause On To Death A Line. Add Addltinal Lines It Necessary.Immediate Cause(Final Disease Or Condition Resitting In Death) A ACUTE MYOCARDVLL INFARCT - MINS we lace.rows.on Sequentially List Cordrtions, d Any,leading To The Cause Listed On B. SEVERE CORONARY ARTERIOSCLEROSIS Camara YEARS Line A. Enter The Underlying Cause(Disease Or Injury That Initiated ' The Events Resulting In Death)Last C .- a+¢taY.twWUttr D. . ( Pan R.Enter Other asflons_Coaa nn De n&A Nov Ratting In The Underlyvg Cause Chin In Pan I ' 29.Was An Autopsy Performed? 0 Yes ❑No • 30. Were Autopsy Finding Avelable To Complete The Cause Of Death? 0 Yes ❑No ' 31.Did Tdoacoe Use Condone To Death? 32. If Female, .. . 33.Marna Of Death: • . Yes ❑Pnstady❑No ®Uriutam ❑1d R'rraa tw Par nee 0 er.trrs u row a ono 0 net Herne,at norm.vna�env Or ®Natural 0 Honiode ❑Acoder ❑Renting Invesogann 0 One awls.er n.r.w.u an ids t..r sin.act ®unman ispamsvaaThe , ❑Suiade❑Coop Na Be Determined 34.Dale Of Injury(MondVDay Near) 35 Ttme Of Inryry 38. Place Of Irtrysy(E.G.,Decedents Home,Construction Sae,Restaurant,Wooded Area) 37. Irjtry At Wax? • ❑Yes ❑No • 38. Location Of lriLy-State 38a. City Or Ten i Set. Sleet a N$nL`r Sec. Apt No. 33d. Zio Code 39. Describe How'wry atoned u Treispaista lnpry, oeoy: - 40 w..m.mt O'.rrra Omarma am.ISn at. Signal re, Of Person Ca:yig Cause Of Deatn 42. Center (Check OrW Pin) • BARRETT W. DOYLE , BY ELECTRONIC SIGNATURE ❑Cemfyirg Prysaoan ®eera,er 0 Heath Officer 43. Name,Address And Zip Code Of Person Certyng Cane Of Death: m. License Number 45. Date Cafa5ed t BARRETT W. DOYLE ,520 SOUTH MAIN ST, PRINCETON,IN 47670- .: 09/24/2014 e6. Add:vorW Funeral Service Roridet. 47. ••A'as. • 45. Signature S nature Local Heath O _ !9 For Rag stir Only Dare FUed(MontvDryfYea) IBRUCE BRINK JR.VIA.ELECTRONIC SIGNATURE . SEP 25 2014 AMENDMENT TO CERTIFICATE OF DEATH(ENTRY.OR ORIGINAL) € . . ya.� � l� D� -yo4 © oar : ga� �. � , z � ` , State farm 53395 ATTENTiON ESTATE:The Social Security Y is being reQxsted Ly ides stele agency 1n ender to Pursue reisponsmEt9y Disclosures oluntary and there will 1R no pena.'y for refuss6 W ' ORIGINAL'DOCUMENT HAS A MULTICOLORED BACKGROUND ON SPECIAL WHITS SECURITY PAPER AND THE GREAT SEAL OE THE STATE OF INDIANA ON BACKTNAT' -...YWARNING•..TUFNSFROMORANGE:TO YELLOW WHEN RUBBED,ORIGINALOOCUMENTHASNIDDENVOID ON FRONTTHAT:APPEARS WHEN PHOTOCOPIEDf 7t“-...-777. 'w