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Death Certificate - Riddle, Donald_12/16/2015.� y � , � �' ` INDIANA STATE:DEPARTMENT OF HEALTH °r -°L -. y , t ; ` . , 3 > CERTIEICA7E OF DEATH : ` �r - , � �, °�ooa�?No.002518 �. ` ` � EDR;No 000000481399 " � s�ce N .f�DO�.VC6'sLeyb�M1S.mIFvsCAEOk.La4)�:;: . � , s'1e.'.NZideiiNane011mH�e)". �. 2.Sez::::_ '.3:Tr.0 . . - - J. - : .� DONALD:RIDDLE ` J � � � _ �� , �MALE' `�03 5. SodalSminry NianDa Ba. Aqe- Yrs �. Bo_ Urtler 1 Yem; &` UnOC t Moren��6tl. U�Wer 1 Oay 6e. Uncer t Hwr �]. 9ace ol Binn.(MOnWOayKeap '8 Xospaal � ❑ Hospica FX6ry ❑ DeteOetq's Hane ❑ Nursvg ❑ Yes � No ❑ lMivqwri 0 Irywaem � Emeepmry Depanmern Ouyaue�u 0 Oeae on nrtival � �.J� (�aN� t t_ Fatihy Na-ie Qf Ntl hs:Y:on, Gi+e Sbeel aM NvnEeh ST MARY'S MEDICAL CENTER OF EVANSVILLE. INC SOUTH 1100 EAST ea«�r. eauram, SCHOOL GRADUATE OR GED RUTH o�� o��,.�, o a�� o�-�,e. em ❑ Rer.wval Fmn Sa•s m �� +i � \ ? _ : 058017 i . : `: ;' = XDeeh- ' �. �tle0 Dea� IEAno'JWaYIt'a�. ' i '6 PM = 11I28/2015 � tieNpace �Gy ma Sute a Fweiyn Lou4ry) ' VKNOWN, IN�I " = I vntll.agnmCaee'wY,r S � = �.. Manm sw,n u rtre a. oeza� ❑ Marnetl� Mam�. ButSepara:eE ❑ OivvCeE � NWwcE ❑ IlevetN.ameC ❑ Unbw�m , 7 omN �so�.yr PARK LAWN CEMETRY EVANSVILLE, IN i.WazCumxCavar]eEi 2]. NameAnECOmpe:eAxreuOfFineralFaa4ry ❑ ves 0 ho �MB BASHAM MEMORIAL CHAPEL, INC., 226 E. WASHMGTON STREET, OAKLAND Clll', IN 47660 iE. Sqv:ve Ot Inha�a F�neal Sehice licrnstt: 21c. Li[<nse N�.r.nxr (0t Lwsseel: =RRY LEE BASHAM.BY ELECTRONIC SIGNATURE FD01016589 Cause Ot Deat� (See Instrucoons AnE Ezamples) 28. Part I. E:¢er The Gnxin Of Evenis - Diseases, Injunes, Or Canp4ratiom -TIia:OireCJyCauzeC The Death Do Not En:er Tertninal Even(s Suc� As GarQac Mes� Res"'va:ory Mest, Or Venvrcvlar Fibnlla:ion W:'wn Show'vg The E',iolopy. Do Not Aborevia:e. En:er ONi Orre Ca•.ae On A Im. 0.]C ACCneal Lvies I: Necesury. Immetlia;e Cause (Firial Divase Or Cordf,ion ResNti`g In Oeaa) A MESOTHE�IOW+ BRAW AN� SPINAL CORD a.u�aw.cawu.�em SepueNiaYy List Cotk"iuss. N. My, LeaCL�g To The Cause Listetl On' B' a.uro..•u.+.a.mao L'vfe F. En:er TTe UnCalyi.r Ca�se (Disease Or Iryuy That WIU:eO TM Evems Resut:'ug b Der�) L^st � . a.mm�..r�doa . D. ❑ Yes 0 No Appmavna:e Intenaf Osse: To pea l; 6 MONTHS ..,...���,....,.v,�.....a.....�.._._�...._._.._�"'i'____. LJYes LJNo 31. POTOCaraoUfr�'.m:uW.eTODeaN� 32 Ilp_nrsc � - 33. Mamet0lDeYJti [+, xe:A.:,.n�w.irv.... ❑ wm�+�m.ao.n ❑ x.n.wn.e�n�w+ven�uo.nao.�. 0 RaWa� � nomdoe ❑ nmeln � amNnp�rnesc9aoon ❑ res ❑ c�uo�.y � uo O Unw.n.n � ww.�.ae�n.aaca.*.�wa.e.o.a, ❑�.,ve.,.a•v�.�.�.e.,�.rs..., ^ ❑ sdcce p Caeonxeeoe:mniwc 3a. Da•s IX 4µvy (f.M...'�aY'Yea7 :5. T�-� �14yury 36. Place Of inP+Y (E.G.. Oereee�c s Hame. Cmsc`xxn S:e. Resasar4 Nboae�!uwl I 3]. Iryury At NbM1? ❑ Yes ❑ No 3B. Lora:m011rytry'S.�t? — a8a �iryOrTwm . ]9� SVendl:um0er 3BC. A:rc.NO. I 394. ZiPCOEe D. OesmEe Xox ITbY Omr.reO W. 11 Trar:sJO'fe>n UWY. � � Qp�.eqcm Qs�e.v we�i. Qw.vlso�aM1l a1. �re.OlPenanGe^�}irqCeuxOlOeatM1 42. Cefufim (Ctis4aYyOne) JON M HALL . BY ELECTRONIC SIGNATURE . � c�uyvq vM�� ❑�� ❑�erno-�. 4015 . . AMENDMENTTOCERIIFIGATEOFOEATH�ENTRYOROfilGirvny _ J _ /.�� � n. t _ 1 �^ „� � I � . . . . _ ' i • ... � � F' ' S \ . _ ' . . ... �! . .} . . ; ?� ��� � �� ��- �o- oi aao- �Ga. 8��- ao/ ���/� QQ�x �� 5���.�'i�� ��L�D DEC 1�6 2015 GIBSON COUN��R