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Death Certificate - Clark, Rose Anna_2/11/2016
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' ? • t• 7. . -7.% ,.- :-.. t z; • . : ,...T...- t S. .• t •,t, 7, t g ,.* • %--.4 ,, WILLIAM CLARK '•.: :-.. ' : : . , 2 ; . :: %. % % % - Ci.-;...1 'T. E. i>. . HOUSEWIFE... - " • I , : DOMESTIC-4.. L.INDIANA .;;; :: ::. ? ::;.: : "r: ..:: GIASON .:.-'''''',. ,--;':,. .....'•P'".:•e,.... HAUBSTADT. ,,;;•,.;:, ..-kk.I ;;;, :;;;•:sk ,..:"'''....,. , .:::;:i;-.4"S".;II;•ca.s,11•41.st,...14-4t• ,e'' ;:- -;;;•,;(kt ; ; - " 1•E I :s. „_.•::::: . ;": "2,.. :: ' : S. ::;c 4 -, fri•:: -:, --,,, .. -- • ES ; fia..teil0:::40,:+ :::2, ...c.ii, •:; 411 EAST CHURCH STREET STREET EAST"- ; s- 3 t .3 k S ; s -.; ss - 1-! ‘.2.,.. 2...,-; t % : : ": • .-{,- 47639 i_-• :4 ,-;.-;;;44,,‘;:•741. •S. -;-,-::: , els:ix:wanes Ethrara: s.:,- , ' ;:,t.ss• -s 2.0.pectiden,oftrIspri90.0,1-...; ;,-.., ; e,;:.•‘ : .21::Docedenrftact; t -;....: 1 ,r,-,.,,., .:- ,gt-t.,,r ;-;, (...t.7-.71 ir,..,-.::;‘■ii : -1161-1SelidoCdkAbUktEPR dtD '. .2 - - :. .*: ...,-4- `\,,,,,..:”" cz4, (- 11.ri-1.'•5:„4..ii11::;2_ .,„, 4'-•:,• .., .c, :: r.L...,<:„15.:tir,:;>::::,, COMPLETED:::::-: ::: :: :-;:';' / .. NOT HISPANIC;"--I; .4------;.-.1■83:::, iihiie:-:;"'"r... :"::::::—,::-.:',$,:r•', .— „ -, :, :-,tj..,-_z>.r.-.,,-.. ?-z..."-.S: ,. '22 Felten Nat"(First'Aida,LaFi)t i 't t C t ;" (: t'. --';;'': '7 : : ti'" '.• 23Ypthcrs Name(Fiat li°1°siat.. t -7:- ''. I•: 23;°m?2;,s,M,t.Fl n Ia s iName ?”V2I .5 • , ' i 4 '; : • r ?St .r ) S : e . -.I:. 5l•.. ERNEST.J.i1NRIGHT :: : l• • I i , k i ::, s-; I — EVKVVRIGHT.;\--- • .:- k. ; i;f:s : ; , GOODSON , ..:V....ft:Uri!: 1. .. •24.lntcm-ara's Name-. :.' ,c t• ,, .: .' •2 4 a.lielayabblip To Decedent •;,,,,/:., 24b Mang Manus(Street And?As, .City State 2,1C1re)5- 3 7 2. : ,,,, -,, m;3,.-.....43 .;,€,,iii;, 54,3 711:s:: :,..3%.->sl ,).•\3... ..--''' „,, . .lfj3J.7...::: '.4;`7, ) , 3.. -Flyt7c/21.7::,:..S7C522-7. .2L.L=- 55.•: -. ..7: ', -; - <7 •..IL" l`...7" . ...9 r<' l'l WILLIAM CLARK:. '".. ..-Y'—' . ---: ; HUSBAND. • er:".":::;: ••••"*, 411;EAST-CHURCH STREET STREET EASTTHAUBSTADTIN'47639:4;1?:/;:-. T. • .-1 c2...2 2: . 2%. r :, :•- . 3'.. Fs2:.-=-r■SC.kt'S. --..-::"2 ' 21iiic;Ce54:44.70nr'12.1!2.22/4/1,422...tt.?„-:-.212 K::2,2,-.-.. :: :: k. "2-. I .25a Meted Of DthtesSon 5 5 " .. . :ii : 25b.Flats Of Disposium(Maine Of Cede:dn.Crematory,Otte(Race)• 25c.17catten 7 City.Tom-ItAm State.,' - T :17— -.7 -;7.(' tstt.Szsg,M7 sg St- -12 tL 12-- .? 0 6t4i.,iiipZfii:.,-,.•.', ' .4) '...,,,,. •- CLARK CEMETERY,...:' .:.........--- ii:C,,::..,, : owENsviLLE,IN•, , -. . ': .:... .i • . ,:ri..:-...-.2■fliri:::: (1. .3" ..::: ••=z--->r;!::,-;,•:,,,, .„•'. ,:.:-.• -,;•..‘."r::••; •i -.:•.--. 5 -: ),-;::-St. -1," 1---,-,''f .>" ji• ' .-'1..•••,“••,,•..1 _ ,7e-':',‘' \'• , I: % If :•.-•••;3'•::::•:::::3T-7":"S""sn s ••• r,..-11,--..oi; •-••• ,,'• .,,,,..11--ic-,,, r•-.4:- : ‘...,..."..: ::-• STODGHILL"FUNERALIHOME'INC 500 E PARK ST Ht 168, FORT:BFLANCH,•IN 47648 S_ ; FH10900013; r.i 10.%7•7.1i f ;St lf. grsztEignedire Of Indiana Fularat sondes Ucensee:is 1-:.-$K, rt.c.g.n.,T7,s--s-s_nt•Tsz.7-stis-t.-.Z-'•-•,,Tygr,,-(g..-1-..ft:-t t---tt,z g i gg,27c,V7tinse Number(of licensee); -.:.-." Z-5.ts z:.;. S7:,,-.Ctgt FC 1... ANDREA LYNN VINCENT;BY:ECECTRONIC SIGNATURE :11:-.4,::.::t"7,481.7.-::: ... -:-; l'3J.„3.41 l ,33 FD21400005: ' 'Cr r.- ": ':: .:' ?r• 1,..-.:.:Ifit-ey, i; c.:.••• ;•<>--;;;,c.: .c>;;I;;;;;_cc 3 .;z:,; ?1,:•:.;":C_Z.Z. ;ZAcr-C •f...z.■:zic<Causepf Death;(Sae Inst.:niche(trd ExemdIrn„:.,;%gc,....,--.4:g•ir-,,,• --, • 43 33;,,,,,...--.3,:•5,441,31ig,343:1;5-;,' k, 28 P,rti?Enter•The c.h;th Of E-t-dhirs -Discsse.;thias oie,amblicatbni-=That Datd17;Caused Th4;'gawk Do Not Ehter-TeiMinal E;inli"?..,It't-"'7• '' ... - "---;:, -,Intervet-toidet!t-S:.5., I Such As Caidiao Arresg Reppira•gy_Aiiest,Orvents-cat Fibrillation Yvithoul sfioy.rigpr Etkdoiy:Do Not At,brwato cnteFooy One ,r , • -.,' - : 0„, •-•„, ii5941a16r,,,, .. car, ,... AUne7-1A6d Addtilillinei tf Necessaiy.' .-t- - -S-- t, tt:,. r--.- t 7,gt.tE-d ..,:(. 7.. .43..(S:7 sg •%.• 'ztt- r 7 ..•1/4-zz,...s. r c. . '3 m : ;,:• ? ImmediateCause(Final Disease 0(Condition Resulting In Death) .-.. A ALZHEIMERS . - • 7 t- - ..tt t.„ ...-.1 . - -t s-• - • - - --2 YEARS..s. h. - i. .' , 55 .1 - . 17 . . . '. 3 ) 7 31 4,-:."‘W33 '54.i32"2-D" 232" 05? ' j ; 3 r Z ; 2' -,,' 17155l ..-5; V. l.l 3 '...:56bUe-ptiapi List Zcidditni::if ANT:Leadicig To The Cause Listed Oh,czt;„• „,..::-.•„ ..71, -4,.-,31- 7,73.,Cull e 10•m 4 Cat.q.n.. cE13.11, :.,,. -...- .,,,.,,,- . 1e. :tine A::Enter The Undirlking Cause(Dieaso Orbitiy Th41 triltied "S 7, .;•'f'"' i. .i 2.•-: ; '...> ,I - h 7. . 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