Death Certificate - Simpson, Lois M_9/11/2015 r , 1 1 I., 1 . .1 , 1,1 I . I ' 1 . • .I " I ' , r, 'I a1 . i 41 ' ' 1 ' i ,
INDIANA STATE DEPARTMENT OF HEALTH 741894
"ET+ CERTIFICATE OF DEATH
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Local No 001670 EDR No 000000216474 State No 039577
I I Gecaer.:e;e9al ttre (F✓st.m,:::.L351 1a Maiden Name Or female) 2.See 3 Time Of Deem d Date Cl De3T (MontoDTi'ie32 1
ILOL3 LI SIMPSON MAUCK FEMALE 08:03 AM • 08/25/2011 I
_1 _78 Morons I Days j1 nosy. Minates 03/03/1933 GIBSON COUNTY, IN '
;cvrr Sanreeaeo i : In it Deem Gcc.,ea In Anese:al I I^a II Dean?Nned Some.nere 0mM Thar.:nosntat ---_--__ .
0■., .':1 en. ❑Ursnasn 'waters 0 nosoce .a, 0 Ceceaems Home n 0 Nursing Homeaaag-lerm Dale Few;
i'� 0 E 'eryen:,Dena:AnentOutpatient 0 Da 0Omei(saec,l,)
ii-Marta':):-ra"i:o insttu:01-One Sueet and runean
;DEACONESS HOSPITAL INC _ 1
I '_Cie,;e;Tom Slate kw Do C:ne 13 Crwati 01 Deem I< MantaSlaysAlTaeOfDeam-
Marnea 0 Nemec Eat Separates 0 Diewe I
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EVANSVILLE, IN, 47747 VANDERBURGH 0 LMdoeeo 0 Neve,Ma q �n U^.noen 1
II 5 wane Sparse'ame 15a 0:ladejGlm hla,aen'_ail Name 1E. Decedent s Usual Occupation ( 17. And Of bunnesslrauustry I
I NOLAN SIMPSON HOMEMAKER I DOMESTIC I
1 '_ Feeul_a'e Slate l'ea Tomo 1 sa0. Ou Or row 1
•INDIANA. _ I GIBSON I FORT BRANCH I
t' er+2'CTS..,b —_—_— lee Apt No 13e Zip Cole :5I inside C.ry L.'a sa
X986-WEST SR P>8 0 Ids n rim
1.Ea.a>:,, 47648 i
-- I20 Dx:Meat Of Osswx Gage 12: P!:eoa4s Race
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8TH GiRADE On LESS INOT HISPANIC IV:'nite _
�2? :3tn ;Dame/T au tt aae 1st/ 22. :mother s Name(First,:.Cale.Last) :33 Manes:/3s<r Last Name I
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I ARVA MAUCK ZELLA MARIE CLEVENGER I HESS •
24 ..--mom s'Arne Refacon sap To Dececenl 240 Mating Accress (Street;no::umber,CAE Slate,Do Ccve) 1
!NOLAN SIMPSON SPOUSE 986 WEST SR 168. FORT BRANCH, IN 47648 I
25 Place 0110 coos:pm
:D nt se Ci L nvs Lc. 12_ie Place Of O,spas,t-•n Name Of Ceme:eD.Ciematari Omer P?a:el 25c Location.City.Teen,Area State I
I:.: ' 01., I-1 Otto: 0 E rur'Lni•nt
U der:i:l.F,(„ Sty:,f
n oy.- .Ete:n.1't _ MAUCK CEMETERY IOWENSVILLE, IN
Ccr 't.- 7Lante arc Complete>airess Of rmera Fatly ^:
;3 t 1.' .IA:e,:.
!COLVIN FUNERAL HOME INC 425 N MAIN ST., PRINCETON, IN 47670 FH33005671
1'2- +w=„ue 0:i;'LA,:v1neb See.:aupen>ee-- _ — — - ro-.
Ltense N tC!Innseel- -------
iOHr!''A WELLS . BY ELECTRONIC SIGNATURE I FD01009940
1 - - -- ------ - -- -- -- ---- Cause Of Death (See Instructions And Examples) --- --1
l IntovaL Otr
? Pao E c D l t�F._its r Due r Ve,hoer. r ib Or Cemollu.tnou-That
y:m w se Cxlogy The Deem Do Not Enter Terminal Events Caul to Dee Oro:•
1 Saco As CooLac
Acetr at t a s If tteay Guest Or Var.:rwlar Fonllauon 11Y,nbvt sno.vm3 Toe Etiology Da Npt Abpre'+late Enter Only One Cause On to Dea'ui
InL•e NaAec set L.'isll::aceassry -
1 „naa:a C at,se1Et2!Dist:se Of Cow lion Resoling In Death) A SUBENDOCARDIAL MYOCARDIAL INFARCTION 3DAYS
I
I >q Am.c't,ua Coec Ion II Any.Ldad no T:ire Cause Listee On B PULMONARY EDEMA
t..-A timer I 'Ai-9/En;Cause(Disease Or Inury root Initiated a.•„o-..,c......i..�.x,
1 Pe F., e, .c sin itaun Last
- C SEPSIS
i
D ACUTE RENAL FAILURE
i 4'::1. [n4.e--;S,or__Tits3n:tam Cerra oJp aea9 Out):M Res:slig In The Lnweet j Cause Ginn In PanI 129 ` as:Jn Autopsy Per:weed' 0{CS No
9 --_—
L..r
,So PS:S 130 Were AL:opry Hwang AVanmle To Complete One Cause Of De WY'
e. ❑nn
1 is sew sr, n De_,ri i2 gr n_i-- 33 'd inner Of Dwain'
Ll a .rt . _. Cter. 10. . ,r ..a.ace s-c 0 r..-. .,-.r.. 0. ,e,.3. .. er,III_.n[tin I 9 Natural 0 namvoe 0 Acaae.. "l Penang scar
i I,`, ,,..r 0 : _ -e-r ,........r, I 0 Su:de n Co,u Not se wteamneo
Da�•_un,try•i"gi n'.C. aa) i _ Some Of Ifsury� b,l 8 Place Ct!Wes S Decedent's Home.Cons:rixuon Site Restaurant'Woodec Areal ; !Rue;0l'veil
I j 0 Yes 0 Na
I35 Lscsoan CTfIn,ur State 33a City Or Teen 38o Sheet&Nurser 35c =r1 0.0 3,Es. up Owe
1
1 29 sHver p-Has'r{u cwne. D I.i3Oror...s,.Dn lM i S`per� Ec ., .,.,, _I
:t ^,-a'e CI Per ton Cerutyiri Cause Cr Death F 2 Cemier ICnece cWuy @lei
-D''.7e\RD NATHANIEL. MOORE , BY ELECTRONIC SIGNATURE I 9 Cemrnm Pnys,oan 0 coroner . 0 ream Dicer
.--e ..a..-.:V.na:-p Dote Or Pi-Isun CAM eg Cause 0,Deun 44 Laense Norwer _ :re Ce:.la 4.
I_ED'A{__RD.NATHA.NIEt. MOORE . 415 WEST COLUMBIA STREET, EVANSVILLE. IN 47710 01037835A 09/09/2011
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9 For Registrar Only -Date F[e:(C-wit,r..3yn cul
IR_AYMONO:A! i ICHO1-SON.JR_ VIA ELECTRONIC SIGNATURE ( SEP 12 2011 i
r - -- __ _- - _ _ AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) 1
ab-18-13-2 oo -000 654 - nos
-u..etacs:^a34: 4— IiO::ESTATE Toy Sooal Secure Is De no remastee C:;n,slate agony in ace/ o pursue response:4:Y ass'o ere is voluntary and Mere well oe no:enaLy for r of:sal
IVRA-20
(7/05) m- _.. . • •