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Death Certificate - Neaveill, Charles L_5/6/2015 11"..''''''' . --------- -- --- ----------------dtpserm-Ertro- r ' -' e,"",'" ' ' ." " r. - ' • - INDTANWSTATE - . A , ._..„.. . ._ ,... ..... .... _. ....;,,127-- .■,,, .,,,,, 77, i, :',;r ,P7:',.. 771 7: 1 • ....!.„..,,,,,,, , „.,,,,;•,.,.• .:., 7,.... :` 7r„,..;--.:- •---,.,-; g,--;. p, -c.--:0:-.:-- -,-;-."---...--‘ `-z; ft % ', ".,--; 1 :: 1,---• .1. °I.:.tEFitiFICATEOE.DEATN" .' l'.. :7.; .f: , r. .t.... 'z.,.•..-2-,'.1: ...,i-:; ,,P.-.`qi,. it...,. F 't if ..-.. ..; '..t '; ! .t.•-., . :/ , i .,-, • .... i .-- - ..:,. ,..,1,- : •., ----- - - , ... , - .. . •-• : : : r., : i, ...-• ,-i----,.. • :- •.-., ,-. '. , i ;1“•:j..Ltit.-21" -.-..„ Local No 000053 -, ; -; -,,EOR No 000000438766--,..,,c (.,; StUto.Not U 14U1 2- r 71 ,:-7:::... 77-1: ir 77` 7 7777., ;77 :: ;. :7 :; /77- 7.•••7,4 :•977'''" , '7.` ,•-•': 7-1<. ,7/7, '777.f.:„ .;•.•14,.. ):;:, ,;;:i:;', • CHARLES NEAVEILL '‘ -k. S . , .;..7 .."'"""... ' I. -A.! ...""`", 's •: '. 'Lt i./ .N.'-‘ kMALE z.' .^-,0235 PM ..z: ..'" -:"" .,.03/1712015{ ..:., _, 74 -; .•: 74 i s Months: -;. ,” PeYT, / ;11" 1:;' i4 "1Minutes .i... i b' T-.'", -.POSEY bOONT,Y, IN 9.,Eve(in U.S.Armed Forces? 10.If Death Oconee in A Hostatat '. " 10a. U . Occurred Somewhere Olhir ThanA Hospita/ - " 4- „. ...,.,- ?- / ••- ',,,,,'•. 0 Hospice Faitty 0 Decederti Home 0 Nursing Home/Long-term Care Faddy '., t, ..... , •" 0 Yes 0 No 0 Unknown 0[neaten: 0 Em■ergencY DePariment Outhebent 0 Dead on Arnvar n and'(spei,'fy) • ••- , . r 11.:Facity Name!(tf Not Instaracn,Give So-eel and Number) ' ' ' , • • '106 SOUTH SCOTT STREET • " • N % ; .:. ;.".. - , -. 12.City Or Town.State.Ard zip Ccoe , ' 711 9791-^171WIRea21 ' 14. Manta/Status At Time Of Death . . . 0 Manied 0 Married;But Separated 0. . . . . OWENSVILLE, IN,47665 . ,: ,:, :•., 'Th.-J. GIBSON • • _ - 0.VAdowed . 0 Never Maned..0 Un thc.r. . •- -I; IS Surviving Spouse's Name . ; ,. 15a (If W:e)Give Maiden LaSt!lame - 3 16. Decedents Usual 0c:cups:on - 17, Kind Of Businessindushy • , . . . , DELORES J NEAVEILL . •• TAYLOR " "... ; . LABORER • . MANUFACTURING , -. 18 Residence-Stale 18a.Cany , . . . INDIANA GIBSON . -' ' . •• OWENSVILLE , - . • 15c Steer And Number 184. Apt No. 18e. Zip Code 18f. Inside Gay Limits? t ' ; • ' ' 106 SOU-TH SCOTT STREET 47665 @ Yes 0 No. . . .. 19. Decedents Easton , 20. Decadent Of Hispanic()nem, :, , , ,. ,21. Decedent 5 Race • . j HIGH SCHOOL GP.AD'JATE OR GED , • . 'COMPLETED ' . NOT HISPANIC - '.. ,.•-•-- :.. .-' -. White , 22.Fathers Name(First.Maide.last) . , . ..3. • ' ,- 7 ' 23 Mcgliers Natl..(Foot Middle.Last) 23a Mothers Maiden Last Name • , . . • . ' " DELBERT JEFFERSON NEAVEILL , . .; : ; ,, MARY LOUISE NEAVEILL BRANbENSTEIN ..' 24.Informants Name 24a Relatonsrip To Decedent ",, ,•245.Mane AddreSS (Street And NuMber,City,State,Zip Coble) , ' , . . , • DELORES J NEAVILLE . WIFE . -• . 106-SOUTH SCOTT STREET,OWENSVILLE, IN 47665 - ' 25a.Method Of DsposMon 250.Place Of Disposition (Name Of Cemetery,Cremathry.Other Place) 25c.Lccaaon-Coy.Town,And State O'Buial ID Cremation 0 Donaton 0 Entombment . • 0 kimmial From State . ,.... .., ". .. ...' . 0 Caner(Specify): , OWENSVIILLE CEMETERY . .1 OWENSVILLE, IN . ' 25 Was Carer Contacted? 27. Name tat Complete Address Of FLasfl Fealty x . . ,27a Funeral Home License Number r HOLDERS FUNERAL HOME OF GIBSON COUNTY, INC.', 319 SOUTH MAIN STREET, . , LA Yes 0 No . . . . , OVVENSVILLE.IIN 47665 . . . FH89000021 270. Signature 01 inoana Funeral Service Licensee: 3 „ " 27c. License Number(Of Licensee): RANDALL K DIKE, BY ELECTRONIC SIGNATURE..,.• . • F001010177 .. Cause Of Death (See Instructions And Examples) . 2E Past L Enter The ChaM Of Even t5 -Diseases,Injuries Or Complicatrins-That Directly Caused The Death.Do Not Enter Ternral Events APPrInteZtimOatnsee t-.; Such As Cardiac Arrest,Respiratory Arrest,Or Ventricvlar FftsrilLaticn Wtlx42Shoiring The Etiology.Do Not AtterViste"Enter Only One Cause On To Death A Lire. Add Additinal Lines It Necessary. Immediate Cause(Final Disease Or Condition Resulting In Death) A COLON GANGER WITH LUNG AND LIVER METASTASES 5 YEARS , , - , . ,. . owl.m.o.•Coon...Ot. . . Sequentially List Conditions, It Any.Leading To The Cause Listed On B- ' . • ., . • . , .. • . 0,...„,‘„,,,,,,0,t, Line A. Enter The Underlying Cause(Disease Or Injury That Initiated .. . - • The Events Resultirg In Dean)Last C. ' • ' " ': 1 . . . . • • , . , 1 ' Part II.Enter Other Siorrficant Conditions Contributing to Death But Not Resulting In The Underlying Cause Gvin In Part I .' 29. Was An Autopsy Perfcceed? ' 0 Yea 0 No , , .,- 30.Were AutOpsy Fes:fing Available To Complete The Cause Of Deatb2 ci ys b,Ndi. . , 31. Do Tobacco Use Conothtsc To Death? 32.if Female , , „ 33. Mama Ce Death: •. 0-,..,..m,....,-...,.., 0.,.,,... ..or D..,. 0 ht.p,„,......mr.coarr a on.cider. 0 Natiral 0 Homicide 0 Aurora 0 Peng Invistgabon • 0 Yes 0 Probably 0 No 0 Unknown , . , , 0...,........ex Pik...a c...To i har kin Deen 0 tiniran ll PT:raraVatin in,pa rear , 0 cockle 0 Come Na Be Determined i. 34.Date Of Injury(Month/Day/Year) 35. Time Of Injury . 38, Place Of Injury(E.G.,Decedents Home,Construction Site,Restaurant Wooded Areal ' 37. usury At Work? - • . .•' 0 Yes 0 No • . . . . ' 35 Lawton Of Injury•Sra Ma City Or Town ' , 38b.•Street&Nurrher 38c Apt No . 360. Zip Code . - 39 Descnbe Nov Injury Occurred . . . ' • ,,• , 4 If Tr:aonspo iocnY. oecfr 0 onewns Oa,. UP.fte.e n Doe (son,' ' -., 41.Sigcust.4e, of Pence:Car:lying Cause 01 Death: ' " . . . 42. Canines (Check Only Ole)) . j MAQBOOL AHMED, BY ELECTRONIC SIGNATURE • '. . . •- , ' 0 certifying Phystian 0 Coroner 0 Heath Of5car . 43. Nate,Address And Zm Code 01 Person Certifying Case Of Death: . ad. Lame Number 45. Des Oersted ',. MAQBOOL AHMED ,421 CHESTNUT ST,EVANSVILLE, IN 47713 „ . .. 01054343A ' 03/23/2015 46.Adcutiona/FuneralService Provider . , 47. -Akas: . . . ' „. . , . 4; 48. Signathre of LOU/Heath Ot5cer ' . . .. • 1 "3 BRUCE BRINK JR:VIA'ELECTRONIC SIGNATURE s •••••', -, t. : „ s s - . i i . ", . . -'t'MAR-24 2015 • • 7 7: ' ' ". 7. 7 - ,- ' :• ; ; 7 7 ,-; : AMENDMENT TO.CER11FICATE OF DEATH(ENTRY OR ORIGINAL) , z t 7 " 7 '; ;1 :: ; 7 : 7- : •:' • - .. - .. . , , • . . -,. , , .-- • • . . . , • . " -•,. % ' • ,--- \ '. ,Liciroao- ::-•:, f---•,..,.: ,,. ,:, .,- ,--,,,. . :2:- ,---,. •::„. , ,, it .„--,,,, ,, ,: .,4 --,. .i. t-4 „96,-zi. 1-'8 -.0 1-..:: c),/ --citco..: , -; : r :, 1 _, i q ( - :.: •. ' -.., :i s.- , „Ste:11504m 53395 ATTENTION ESTATE The Scciril Secunty*is being requested by Use Sire sgercy in urusit5rjorr/usrispataipltity;Disclostia is volunM/y.and there oil berm periatyfofnefusal..f... ; - ..... WARNING: ORIGINAL•0000M ENT HAS A MUiTICOLf3RECi ELACKG5bUNO ON SPECIAL WI-ilia SECIJONY PApER'AND-1)-{E OREAT SEAL Op..TVE STATEQPINDMINAON BACk.ThZATcr.,--‘ R PROMO-• ET•y •AlW11 MR Eir 0 •RI • e• MENT HILMEN. •ID•NFR• ..,,,. Yr.- , • , • „ , !,-:111*.-r....:!w14'.1(r::ztir :1.ireff..i•Sc/6:11,11:".:,,Y,-rt..zz.7111'itr:;r:V:./I'-.--.