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Death Certificate - Kidd, Ruth_5/8/2015 ••i-.:::„T-2---;;;7:;-::=•:-.7,---;;;;;:7-,-;--- ,c-•:77-----.•-•-•'•-i-ibiiiAkifiiik-7-------:-----. --- - - - Yr '''',:r!'---1.t. 1 ,"; ,11%),,q1,■, N,.‘c, :c.k,...±..„...;,... ;,... _ ...HE,44:1111( . . , i ;T:>-..-51!iti-,-----';.:.,., •::v.z.,..;;.tt-i - ..,:z 1. ; ;,-,;- ii.:s;;4..pERIIFICATE!OFTIDEATH I:It% :1 - ; 'IC": - , :i'' 3rk,',99L:. 1 • ' ' 49,...,9 :-..._-%;: tirt.');;;:li yr%iff.4. .r.fi',;•t-i-;tii. y !,- :. ; i -,, ..-. _ .--,c,,h;,,,,,.R..k.1:- --.-- ., -:-...:,. .---:, -J,..<c .5c. Local No .' '..' . ',..-7,EDFt No 000000439554 -/ ' ?:Stal&No:01427.uid,-,-f.,.,:t,..,,,...,.. & .cp,i f ..4 ' - --, --..; ---.. ,',,, e;" -:. / , ; L,:e< ..,,, 't.,"; -t"-. ,, - : f--,:: ...,---,,, - -•-.. :-,., ,,---L --?'9,,,,,!:-,"::: 3; RUTH M KIDCT .-L31. 1I-L r ''-'-z\: 1 .:!: 1? ."---""k -":. DEASEL-: -.4.-.-CL::. -....Z :II" -.;':. .3.3•`-':: FEMALE.. -'567.:45 AM.S.:... r rt.-y/5.'03/22/2015, :::3333-.. -3.:1-.. .I -.3.. .17.71°nrni .7 '' .632, '3 f; . Hers%77% % ,: MInut".s ket i•• •. .. Hospital, L., 3„ -- . ,,' 2. .3 9.4, t•,- ,' , 4,......,4 ..,.. -44, 3,...,4 s...,, ,4.9", 29.(99-,.-", ,..99:tt 0 Hospice Facety p --Deerts Hare p Nur. Hanekcogienn Care 1555.,y. .-„.-3,..;,c,. -3::.•,,,, ,„/ . . 3 . 7 11.Facety Name Of Not Ins:at:on.Give Seeet and Number) i • z 3 ( ( 7 5 :7 ;• t . . •. 7 • 328 NORTH HART STREET, . - • -3. . 1 ; '312:Gay Or Town:State,An3 Zip Code r ., 34: -. -, 3 ,- 3 : • 3 : 9 : 139Goirity Of Death ' , ; ' ,' 14:.mantz a3 Status At T.Of Death 1 : , . i. .. . .„ 9 ; - • ,„„. .. .t - - ,• b'emn't.,d 0 5Irpea:I3&'s0-4.2'''' 0 D '''`' !: PRINCETON, IN,.47670 . - - .. : _ . :. 15.Saviving Spouses Name 3 - -- 15a.Of Wie)Gve Maiden Last Name - i ' • 98.,Decectenrs Usual OCOVEltal ' •• %17. Kin!Of Btispiessendiscy,„. .1 FRANCIS PATRICK KIDD ‘3k! .: SECRETARY . .‘" .7 % MEAT PROCESSING i .ie:Residerre-Sos's 7 ' , ,• . .5 - ' - . .3 • . . . . . INDIANA .. - GIBSON -: :: ":-. ..-: ---. PRINCETON -,-- . • . 18E_Steel Aro Number ; • . . . , : . i : • : : - ' . 0 Yes 0 No ' f 328 NORTH HART STREET, .3 I -! t ; •-: s 3 .: . 7' / , .. , . : : :476io-, . : : 1- .19_Decedents Educ7xo,: ; ;, , 20. Decedent Of Hispanic Origin : I., ...9 3 - 21. Decedents Race HIGH SCHOOL GRADUATE OR GED . - ..„ , - .• ,/„.: . , ...- COMPLETED \-. -3 .:- '3- NOT-HISPANIC-. - , . - - --. :-.--\ White ..- - •,.. . 22.Fathers Name(FM 1tc(cle.Last) . 23.Mother's Name(First middle,last) - - 23a Motha's Maiden last Name • L 7•.: i' • L,: •' : ' Li BENJAMIN:HENRY DEASEL LORA DEASELL .- : . , • BREMER . ! I , I I 24a Relaxed-1p To Decedent '39./ 240.Madan Address(Street And Number,City.State,Zip Code) '. - . •!" ,-:: - : L.., .....- ;, .,... , , .... ,/ '_ .. ,- , ,, FRANC.IS PATRICK KIDD. • HUSBAND.. :- L .: -- • 328'NORTH HART STREET,PRINCETON,-IN.47670 ..•:-• - - : . 25a Method Of Deposita, 9' • 9 250.Place Of Disposioce (Name Of Cemetery,Crematory,Other Place) 25c.Laces«.City,Toon,And Stale . - ' .. . . . . CI Basal 0 Canton- . 0 1.01later 9•EntanOmebt ' . %. 7 :•1. 7 :: .; 7 7 5: .7 , • 0 Removal Free(Sate MIDWEST FUNERAL HOME AND CREMATION ' „,% - . • .: 0 055;(SPeci98: ••'' '9-.3r" FORT WAYNE, IN , • •.. , .-- . . . • 28.Was CorcoaCorcastecp, 9 . 27. Name And Camp4ete Address Of Funeral Facdty 9, ,L,' -"-•a f- "1,, :2' 9-3 ... - 99‘ z - ' '3 .• 27e Funeral Home license Mentor_ . . .... . r , .. •., . i. ' • ' ' • MIDWEST FUNERAL HOME&CREMAllON SOCIETY,4602 NEWAYGO RD.:FORT-WAYNE, : - . . 3: : ; 7 • •• i 0 Yes :0 No . .IN 46808 3#3. .3 -3. : 3 3 , i ::: .3 : .• 7 „:' t , %. ., FH10900003 1 . I 1 270.Signraxe Of Indara Fur.eral Service Licensee: : : , % ,. . - I .3' , --‘ 3, , z.- .; •-. - . . 27a License Nuntoer(Ofticensee):- I JOHN FL THOMPSON , BY ELECTRONIC SIGNATURE- :I - , -:-..,- % :. - .' '.. 3... .. FD21300025' . '• r - - •' . , • I! .. ...,. : ‘(.4.Cause Of Death.(See Instructions And Examples) :- . I -•, . 28.Part I:Enter11)8 Ag..__._.:clifaini -Diseases,injuies,OrComolic:aliceti9ThitDectly Cabal The De'alh.Do Not Enter Te7rninal Events . • , ... •lntervat Onset-9, Such As CatcliaiAirest;Respiratory Arrest:Or VenUictdar Fibrthat„ Mlout Showing The Eliaidgy.Do Not AbloreAate:Enter Or One Cause On . To Death 3 • . ' A Line. Add Addtinal Lthes H Necessary. . . . ::-' . - - . . , , „ Immediate Cause(Fthai Disease'Or COndition Residing In Death) A SMALL CELL LUN&CANCER,STAGE s4 ' t . 1 , 9 MONTHS - 9. , • - 9 - . .SePuereially List Card tails If Any,Leading Tc The Cause Listed On 8,- ;"' '... ;""9 '--' " - ' ' • . ' . , - - • • .. . .. -LtheA. Enter The Under-flip Cause(Disease Or Injury That Initiated „ The Events Resulting In Death)Cast . 9 C. ,i•, cepa tas•sc48esure•ce ' - . , • . :,: . . , .• . 'Par:IL Er's'OtherIgsftfrCatiVasCtcote-G.9210Ce,FluNa ResutengLn The Up:tailor.;CauseGit In Pant . 29.,was An AutopSy Perlomed? . ,- ',0 ye's. 0 '140- /,. 1 3 ; -• 4 : ,4 i. 9 ,, -, i , /'.--. 34,9,.Were Autopsy Finding Available To Comp«,The Cause Of Death' 4 Epics ti 1469,, , 31. Did Tcoacce Use Contain To Death? 32, If Femae: - 9: '. 9 i ; :: '9 3"' ; : : •33..manner OfDealit :: ' '': ":9 0 5,.:Pew Nen.**yn. artiaw.it nie or one, 0 tietPreas;71.137/1Pr."74SAIL-in 42 Dry%,OiNitil 0 Natural 0 riorni.6 :0 ACcident 0 Fen";Investigation « 0Prbeably NO Unknown 34.Date Of Injury(Mon•JVDayff eat) ' " 38..Place Of Injury(E.G..Decedent's Haste,Ccnsaucton Site,Restaurant Atoned Mn)9 •37,Lairy At Wad? 9 ' . . . , .. , . . -, •, 0 ri.s4. '0 No •--' . , . , . , . '9 ,„, .• - 3 • . ', . . , 38.Lccabon OfInpry•Szaa t - 38a City Or Town . ' , 33E8-Scan 8 Ninth« . • • 9 ', '9 9 ; 38a Apt Noy- -380 Zip cone :: ; • .. 4 . , . , . . • . . . . . . . . . . . 39. Descnbe Flow la*Occurred • c it Transporca9as Inisy.r,„-__ ...... - ; , 0 CaTeleCindibr OPInalnam Peclaltatn UGC.,ras"..I) , ..---' ,./„'' ,, , „, ,.,,,„- •,, ... . , . ,,,, .,. ... , . . . : 41. Signature/Of Person Cersfyina Cause Of Death, . I. CHRISTOPHER-BRADEN,IBY ELECTRONIC SIGNATURE -:'. : -:'..,..... - ' •i : : "- I30 Cert.-lying Plrysician :. CI Gather -'. . 0 Hein otrat; :- •,, . 43.Name,Address PM Zip Corse Of Person Cer-fying Cause Of Deem: . , . , . ., I - ., CHRISTOPHER BRADEN ,4055 GATEWAY BLVD,-NEVVBURGHNN 47630 . .. i . - 02003326A`:` : '., ‘ ...- 03/2412015 .....' .!• BRUCE BRINK JRI,-VLA ELECTRONIC SIGNAtI.JPE --, c I. t -•:: : I I: 1' j : r .:-.)t.;:fl,: ...3,.!.:.,;: 73 i I.• t: :: : t ,,...c.I,. c.M,A: R2,5..•2 i.0,f 1.,:5..,,n Zk..: : ; . - 'AMENDMENT TOCERTIFMATE OFDEAT (ENTRY,OR ORIGINAL) i 3 ' cab-,,a, ,,p, , 4,-,Ea• ,, „ , , , -- , , o(i I g ,, /6 , , , „ -, „ i -r . ; 11.=::::.EliTS'?-:.:1?;;c:S1,-; c.: ts State Fn 53395 .ATTENTION ESTATE The Social Seco*8 ii 'being rogues ied.'-byfril Stale ageit6r ih eillette:9[Spejesporuitlfity: Disclosure rs volpritaFeandr there yn,....13,,,,penty(01.44,,y23..3. t.9 , r4("5„?i,,,, WARNING' ORIGINAL DOCUMENT HAS A MUL71C0(09E0 0ACK2flptiftO ON SPECIAL'WHITE SECURITY OK9EW.AUD THE GREAT SEAL o:1Si STATE 01EINDf2tVLON E.Ak.THAT:2-'01i;' • TURNS FROM ORANGE To YELLOW WHEN RUBBED.ORIGINAVDOCUMENT.HAs "Ls.)-HIDDEN. •ID ON II:I• .THATAPP - WH- PHOTO •_,.a._•-9..%.9 i:?-9,799I.91-17.7-.1... :-. . ..- ._. .. .. _. .. _ ._,. _ . - .- .. ... -. - .. . _