Death Certificate - King, Mary F_11/6/2015�' '� � r�. * ° INDIANA'STATE DEPQ MENT OF HEALTH
;� ` ' `:CERTIFICATEOF'DEATH� � -'� .
I�,�� u�*s , . : . .
� — ' Local No 002230 = �� � . � �eoR No 000000416729 _ �- � � - sc�ce No. 05311�8�� `�
1.DeuCafYSLe�ibNUVe I�rAMrfale latl . .. . . . ta. MwenNwro.IplrnW�� . .,2 Se � ... -'3:.imeOtOam'"' � �. DneQ10e+N �i
MRY,FKING ��� '� � � MCROBERTS - "�FEMALE� 03.45'PM - � *it/23!'.
: SmTlSmmry N�mp¢� 6a._ ppe - Yrs fib. UMtt 1 Year 6c. UnOV 1 MuYn 6p.'Utqe� t.Dry 6� UMer 1 Hav I.: DSC o19iM (MwYNpay/Year) B. BuYpla[� (Gry anE Sbte a Faeq� �
� 82 A+� oays nan � ri�ies' - ��� .
� XospW �
] Ves � No ❑ Univqwn � �M��e�� � F^�G�Y Oewnrnem QrtG�M � OeaO m Pmval � MoW�e Faci4�Y --� , � OeceOen's Mama ❑ NivsnB Mn^�eM1nq�wm Cara Faciry
❑ OTC(Sper9Y)
S96 SOUTH 325 WEST
13. pY,XOYS �Nra9T.
iIGH SCHOOL GRADUATE OR GED
E KING
!Sa. MeTOa OI Oispovem
�j B�nai p Genabn � DIXUbn 0 fJtmiEment
] Remoral From Sdte
7 Omee ISP�Y)
5. N3s Ccry+er Cavadm'J Z]. Name M
❑ Y B N
m
❑ MuneOO MameO. @it SeOya�ee ❑ Orvorcea
� NbwveC ❑ Newr Mamep ❑ UnNwwn
�
❑ Yes 0 No
es � o COLVIN FUNERAL HOME INC 425 N MAIN ST., PRINCETON, IN 47670 FH83005671
!]o $9�aere0lYaanaFVie(a5ervirelcrosea- Z]c.LicenseN�roerldlicenseel�. �
MRK R. WALTER , BY ELECTRONIC SIGNATURE FD01073010 I
Cause Of DeaN (Sx 4�structims Md Eiampin) �
Apprmimate
Z9 Pan I ENer TM Cnain OI Evenls - Dizeases, Iryvies, Or Complicalions - Tha� Diecty CauseC The DesJ�. �o Not ENer Terminal Everua � Intenal Onsel
Suc� As Cardx Mes�, Respva�«y Mesi. Or VemriaAar F�onlWtbn NAWUt S�w«'vig T1ie Etitlagy. Do No� Aetreviate. E�tter ONy Ore Cause On I To DeaN
A Line Atla Aaotinal Lvies II Necessary.
Mmeaiata Causa (FOaI Dixase Or CaWition ResWting In Oea�h� A ANO%IG BRAIN INJURY I 12 MOU0.5
wnio-u�ui�wpM
Sequem�ay� lis� GonCiwu, Ii hTy, Leano9 To T1ie Cause Lisiec On �� CARDIAC ARPEST I 12 MOURS
Lne A ENer The UMefyng Gause (�isease O� Irryury Tlal lniliatea ' °'tl1p"��°`O"° I
Tne Evervs Resuing In Oezn) Lazi G SEVERE SEP515 DUE TO GftAM NEWTIVE ORGANISM ONE �AY
. we�o..nc...a+pa
D. URINARY TRACT MFECTION � . I ONE DAY
�j Yes ❑ Pmca01� Q No Q Un.�.�.
k". Lorada:01YYWY'Slax
)AVID RYON . 519 HARRIET
❑ i.. , va.,r..r�., � n.v++u:.�.aw� ❑ s..nm��a.�.nw.�aomao..e, '� vaa� � nmlooe L7 Fmcxc C:nmgtr; �.9a�m
❑wn.w•.unw�..�o...ni�...r.o.., ❑u.e.,.n.�+v..,n.n... ❑5�a.�cmoHme�oemmi�.a �
35. Tms p �M+Y J6. Pxe 011nNY (EG . DecaOern's Mome. Cmso-unm Sae. Resavant NuoaeG nreal J�. Y'IVY Rt VMi
I � Yes ❑ No
2�
_. "_"__ ,., .�........ �.,..,.� ....o .,.,..e,,.,o....� .��.,�, e�o.we.,.�,.
�WA��ZNI%Ii�' ��.'�N���UMEMHASAMULTICOIDqEI
�Y �1
un ❑ Cvaw
� . ; Q. 'AiIT 1 . _
1 1
.. . .-w:. F« aroiavar ONY � Dan Fiee MonaWaynear��. t
' . NOV 26'2014 �
❑FiCATEOFOFATH�ENTFtKORORIGINAL�; � � �
��= i5 �oo � ao � d g�l oa. ��r �/l//_/ _
. r . Ai / �/ / )
. ,`.
';; ,
e ape�cy W pter.to pursue�esponsiEiliry.; Ourbwre a voNntary and Ilrere wip De ro pena y lor ielusal. �
fDUt�D ON $PECtAL WHRE SECURIttPAPER AND TNE GRFAT SEAL OF Ti/E STATE'OF INDIANA ON BACK TH4T
_�_....._�_...._i_...�..._.._...._._�..___'__""_'___'__.._._.._..___ . . ..
'__,'__
� � ���_ ..
��-�.��iS-�ioo-bor.b��=od7� ; .,
`-�c��a. ��,�,( �
,
�
I I -�O-1 S �
� I���
NOV 6 2015
GIBSON �OUNT�OR
a