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Death Certificate - Garrett, Jackie Lynn_7/2/2015 ;014:Lei te:E11.11.:4f....;?: : 51fir.iilL rti.",..tiTg.AC'er.:),Air:..41.1 - ' . I ' - It.t-li-Af.xtfl-r.t.a.. Ais!. ).-.L.'z'iiI.-y■-.5131Y-1.-:i:fr Yi:grfel...V.Iiii•.i:,•<•--1., -91W-c...5*-4:2:.:?!F;47:5",te.1174;“EriPl.,/,;•!..11-cl'I'llIff'%II...INDIA H 'A: : ','0 i• - '• ". 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'‘.;• ti...1..: ' ''Is -, tI ''-,..- I1'-, :::''':'•,. r-Us ;*:'::- JACK]E ILNINNtiARHE I 1.:.. r s.:'t..1 '4 -i-• ,?..": ,----"•-... ,. .:•...; '1';:f'":-.c.Z.; ., - .... . 1.•4t'', 1MALtf t' ''06:18AM"7:, ."..-1.fr;'.11/1.1120147 ..-"A^^.. c... , 93 Ezerral.S.Armed Forces?14 to IT Dealt Ocasred In e Nospeat •.., ,....t• 1„, 41 , . flOa If Dean Occurred Someatele bat Than A Hospital; .;. ,i,- '..,. -••-- tsi .5. 4,7i, ..“.. ,j: ig.Yea 0 No aUri/rid:AY 0 Irtett,ent,0!reagent peitell?heet bagsePent 0 Dead on Atha! 'a eia,.;(spiaay) , '"-- . .= &ii•-iiiii er -1 : 1 11,.FacLy Name(If Na Ins:utak Give Soya and Number)' ' ' ' ' ") \ V.< ' :; i t ' " : '', -• ' ) ' L' : I WATERS:OF PRINCETON,THE - .,. ' ' ..,; I . ^ . .. . ;', F.- 3; ,12.:City OE Tow,n,Stas,AndZip Cade, 1 • t ' t - : • 11 Canty Of Death ,' l , . ; 14..Marra!Status At Time Of Death. I ' I 3. .,-.; . .,.: . . , ,., I ..•,„ ..‘"'.. ' • C ''' ' ''''' .' 7 ; '' ' ' '0 iambs°ma‘nied,But Seberfrse 0 cermet, -. PRINCETON1N,47670 i_ -• • . • • . „ -,.•'".. 3f,.. . GIBSON. „1•s::,, :::....c '.-:-'. P.Wric".1.. 0 P,Yef Yarned.•-.P unknFin- 15'. .ss't'ing Spouses Ne!reP ' ' -'..--„ ' 15a. Of Wle)Give Maiden Last Name ; ; , , ...,16_,Oecedeas Usual 0ccupapon f ..; IT. Kind Of Business/Industry . . ' I LINDA GARRETT . ' " . . - . . I i = ;• .. PFAFF ; 1 ., :".. .. i :. . i LABORER !... , l, MANUFACTURING . - . ,.. ‘ , , . 7- , . i . . , -1. INDIANA ./- ." .' H. .. ' . .' GIBSON FRANCISCO 18c.Street And Nara!• ' •I ,' . ,,-' ', , 16a- Apt No ., '1 18e. Zip Cale' ... 181.Inside Cary Lirnits2., 1 , 1 • ' I I % 5: ' ',. ! I: '. :, . . 0 Yes END • 5961...EAST STATE ROAD 64 .. 1 - : . , .. . . . , HIGH SCHOOL GRADUATE-OR GED - , ...,,, . . -.. COMPLETED . '''.. .•:- '''' .'"'' -'". ; . NOT HISPANIC . --. "" '''` --, , . White .."--"-: s''''- 22.Fathers Name(First MOP..Lest/t t -- -• 1 - ir ' .. t •i , ; ; -- 23.MoTMs Name(frSt,miacu.Lasty . - - . 23a Mothers Maicien test Name'I' , . . - '.' ''.. ,.: : ,. - . • . . .. • CHAUNCEY GARRETT t . ; ;; -, % DOSHIA VIRGLE GARRETT . . . ' -; CRANK 24 Irttr.atts Name - ,24a Relationship To Decedent ,.,•• 240.Malmo Aerates (Street And Number City:State,Zip Code) - ", . ',,, ".• , I- • ..: ,.., .% ..' .A , , .■ • ,.. ,. ; LINDA'GARRETT. ". . '' . WIFE ' $'-' •', ., 5961'EASISTAt ER-6AD 64, FRANOISC0,-IN 47649 .^"::. . •• :, . -.. '.. .-" 25:RLIce Of oispoithon '''' -'e '"^-.- ", 41 -- " ' ^- N. ' '' ----- %. 25a Method Of Disposben y: f; ; _ , 253.Place Of Cispositon(Name Of Cemetery,Crerlawy,&her Taco; 25c Lccaton;at.Teem,And Stare - : ' ' - , ,ta Birial 0 Cremaren 0,3;naton Q Entombmen .t ' ' ' - : , CI , • ' RibmWal From State ; . - . . 0 Other(SPeteY):. ...•••••• a.--.. '•.•.,-., MAUMEE CEMETERY "L... . ...^ ‘.. ./ JOHNSON, IN• '`-„• ' ' .. . .. N . I , HOLDERS FUNERAL HOME OF GIBBON COUNTY. INC,;;319 SOUTH MAIN,STREET, 1 1 ; .'" ' .. ' , O ;• , z. D Y'es 0 ; : - • ' OVVENSVI L LE. IN 47665 . ;t II. •:: I i ::, :: i 3 3 1 : : i. •,. ; :-; : :- FH89000021 1 270. Sigra5re Of Inctara Fateral Serves Licensee: i , . , I RANDALL K DIKE, BY ELECTRONIC SIGNATURE . ..--.. , , : -' - , '-- ) . •,,..." : , FD01010177 "' s •". ', .. ' • •. , - ...Cause 01 Death (See instructions,And Examplet),,- tt ,,.: 1 .. .., ... -Appratirriate . .. , 7, ...., ' 28.Part I Enter The tc re_Lg.__E -Diseases,.aftaies,Or COmpletidiOni-Thai CrAntty Caiiiita The Delia Do Not Enter Terminal Events - ' • - ' Interval: Onset Such As Cardiac Attest.Hespiratory Arrest:Or Ventnoutar Faxillation Without showing The Etiology Do Na Abbreviate_Ergot Only One Cause bn -- To Death , • A fait *ad Addlinal Lines If Necessapt ' „ - . , . - Intriec4te Cduse(Final Disease Or Crinditir Rest4ing In Dead') A METASTATIC COLON CANCER -; : : t , • a monm-ta , . . -- . : ,,. : - 1, „ _ . , '• • • , SiOuentia0y List Caidacm, If Any.'Leading To The Cause listed On a ' -'' ,t -I ,.c.a..,...,,, cm ,,, _ , ,. ‘, . line'A Enter The Underlying Cause(Disease Or bitry That Initiated • The,...EveHts Rertittirig In Chiti-)1# t. --t‘A . . , . , • DT . i I ; I , 1, : 2 t t, "r Pan II.Enter Other 9 ..IELCStOilM12/ EAr!'let Restabne In The threereng ,Ceese Ginn In Part I. 29 Was AnAtnops),Performed'? t. :0 ye‘ 0 NI, .'- - . . ' , • ., „...‘ ,A . , ' ' ,t-'' . , '• -•-•`• 30.Mae Aaopsy Finding Avadatie To Camara llie Care Of Ct./mg,. ;1 O'Tes 0 itio , CHRONIC OBSTRUCTIVE 1;111_316NARY.DISDASE,TOBACCO ABUSE • . • - . - .t. .r if- - - •3 31, Did Tatatoopse Ccrantxte Ta Dee? 32.11Femate: ' 113 Ye; 0 Prelably 13 NO 0 Unkneren ,0 ee'eSal roe ea,Yie 0 '-v--s et am atone 0 7:a..erre4rt.Be et Wela a ar€01 as El Date&0 kiitrnicide 0 Accident 0 Perking IrNestaapcc < . ._ .. , I.J 4.01.93...ad'••••••43 Car 7.I Taw inn'.i.' D .. ‘.1‘.4"1,'Ii•P.4 T", 3• 0 SLACide 0 C011id Ncot 8e mined '34.Data CP Iniuny(MateVCayiyear) : , , ' 35,lire Of Injury ' - 33-•Place Of frau),(E.G coecebews Home,Calsauceon Site,Eezawant,Wooded Area) 1.. :22. inaryta Ma?. . - 385. Apt No. :- ,.33d.lip Code ;if : •.. '". % . „ , - • . , • . ; , „ , . • . . • . - , t i . t = : . 1 , , r . . ; , ■ . f . - ' ' ,- - . fl' . .. ,f •; 1 41. Signaape...Of Reran Con:tying Cause of Death: '' I TERRY GEHLHAUSEN;BY ELECTRONIC SIG.NATURE: : ' .., c : .... :/-'i. iI21 eel-eying Prireician, .. 0 Cooner3 f ,0 Heath Officer•: 7' ' „ \ ; ea Name,Address And Zip code DI Rerun Certain°Cause 01 Death: - t • -.. t 7 t , r. ; ; ; 44, License&meet, ; - 3 43 Thaw Cer3fied i ." • ' 3 i 3' .- • • ' . , , , ' TERRY GEHLHAUSEN ',..1020 W.,MORTON;OAKLAND.CiTY.,1N 47660.: -, -' .: .b.. . ..>" . ": 02000736A'...' ..: .... .." 11/13/2014. ..• : ., _. s.. :- : ` ' :. "NOV 14 2014 ... : .• 1 . " BRUCE BRINK 112;:VIA ELECTRONIC SIGNATURE r,"i. 5 , : - -- - -- - - - - - - -- - - -: - • : , k ,r f r ; , t : -, z , , -., AMENDMENT TO CERTIFICATE OF DEATK(ENTRY.OR ORIGINAL) 2 ;. % ; ; 2 2 i • < !- c'2, c • • , . ,..c., - • ' :1'' ''•'. c9:13,13,4rq0 3° OW ID ••:0057 ;-`•f• 1 1 • ''%•,, -''' ' t',„, -'''' •-% ''' •••'- ''' '-% ". /--,,. • ,, fi ,..,- •,. €- r•cc7:.'.i 1. r% I :( -:',,:.-'-• f ' -..••'', ;:.' ‘•,."-•••,„ ... %.ci. •".;4,i1 4„....,,,\.1, , l!'•• (S ''.- '• •5 0/_. -Is in Ac)1 ;- ' 00 310 et:fed '' -''' ' '''. '''" ''. c::-t U':. "': '',.k.":'' :•is,. 1.f'.-'''''.;•'-t• •i: . t't-=•. . .0 4 ,". :g9F. 'e „. 7: t ; --",___": :-.StAfetf FP ,t ATTENTION ES.1:8!X:7Thinmant„.§ficnIltY if is P,sa sews':isiFirtiSilsiggscclin 7,1321,1&ifir..-*Jibil.,..frlD6j°5u- rt.e iiwlurr"ai-irYHii 61tr..thri3LwillibbenPel'ik.-,-.. -Ipritrefusalia::-• ii%i i' .2--i •i -:-:., .i*izZzi-t WARINJING;c0fttGINADD000WENT HAS.4MULTIOOLOAED ELkatteR0113D TONiPick wing SECtfPSTY.PARWAND TittE dREAT,SEAL ift€'2FIE STATE 70.FINDiAgt.r ftattBACkic4Ai .,..TIJRNS FROVORANGE:TO tELLOW WHEN'RUBBEWORIDINACOOCAPAET2T NAS NIDDENVOID ON FRONT TRATAPPEARS WHEN PHOTO COPIED-•%7;• 1;"•••=1:". 'cer-L•ttr''',4>