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Death Certificate - Dillon, Daniel P_2/29/2016
:er'T - - . • _ - . - - ---,- ____ ____.„_________ . ._. _______ ____ _ • &uilliFb_toiAiNAisTAT,i),.„.,-,:,.- 7„;, ,t 7 q•,.;-' _ t ops -it -it- ! :-.virr.11,; -:.,-,-,miirtn ,,-;.;_n_ :- ..t:H-, " *--- -rc..-' s....i.:1 -' • CERTIFICATE'OEDEATH ' - ." 1 4.. ■-' --.- ). --t."--- -v .....- -, - . ft, „.... ....- TT/„.....5 <5,35.--I.:?:',..-FSI--,• „.....0.. .,‘ • I oo. ...." 1-5,"-. 1,, ....- ,, •‘■.."- 1.\-..:5„S'• 'IN,II`.N.Z.,N I .,Ni -, -tsi Jit• •ii...-11: -11?-4-) 111-4,1prc - : -...,:c.-1 III Hir .,---IiiT4Iiiw-x-auvwcilit Ail r c. .4.---- 4, ift--,0t_-:::1,.:r. -IR___< -t , , s ' ("`*" -':- tiO0204'- .4,-'? - '-' ' 000000486666-- r*4 ' -;!: ' - 1"1 "c0609843%; --. ' " • • ' c x-c••• -- • tocal‘N s. i",: 341.-2‘,iDToNc.e&IsdE*eorsVofti4t1tr1o1;4N•-fr..e4-..:i41.1;-..'.-,-L,ft1i),r•- ; :1..-,-.--:,-;,--;-(z:..--;„:I- C...r,.,..? ;-,sa Z1-',..,r.d..:Mi:arellif!•.0*,1..:1--.-ee7.7-ilffilt 2-Sex I-4S 1I0.:51f9;1;IR;ie,"f > 4 Data -:r 5aY DA0pWr„ as SE m Aia -...., V, : 77,7-r47:77 I :. ,W4:Pit. r.:::••,--: D,Iii..:. :2.7! :1;13se::•:::,,):%?4til`...141n144">;....-.:liss:t:"-'1,:i\::•-i09/07/1938•:::.;.."-:- sPIKE.COUNTY;s1W*. - •":: ....... ... It ' 9;Ever int,&Armed Forces?,., .10.y De.aM Cccurred to A jic,epital: '5,, •',52 ZI5E5:...-,..;' 5 Cf.1.1.1 Il .103.1 lf Death Coarse:I Swnewnere OnerTlyetA Hoyt., 56,,,•;,...!..;;•.,(,5 515•.Lf...52„5:1■45,- 1!5-c......,./re (5..c.:I.25".::?..i.;#5.5.,III...-C42<IC i.99" ‘5',..5'..,c.f*:T551 ;:. -5-0,`,.... ' ..,-,`' ,., , .„Z cc-I,,,T.,•stIC,■::::Yig.e:4177'tilra;talri<LE1iDrli7F•El, :1:1 N.1.11.;sing Keg-t?'°are Fa -'11'1'. - i #rs. ..... fr 0 Yei-p ni'5 P uokricoi, of 1,i,on,oro,13.E.in?woof chiParid 9f4#•ert:0 peer46nerroei cliothit( 11› ..-S'Ir. 71-t::;-. .?;...:.;;;■7_,;:..1' .,t.....,... t .k..: 11.FaattyNarne Of Nct Instarico.Give Street and Numnrl< 5, .> ,e.•C 5,I--&...:< .1.1,---.... ..I.,•:---..RErISt•52. 2„vr.... ..,5„.„,,,...., ,, ,.., „ , .. „ _ ..<5 ,c. • . , s.6-• 306 EAST SCHOOL STREET ' ••':- ' . -. % •• . -: c •:Ss- -..: .;-:-.:.N.::. ::".."•:-...›....ss---...>"....•:::::" ,:--z ; % ; •-: :;:. :: : - 7'5 7,7,77S,N,_,. _ .., , 1147. .I.,1.2 Ca.-9I,Tra, .Sara,Ara .75 Cale I III ...5 . i , I'. .,.: . I. ; I I' :".;5, .? ‘1•I'I 51?,CSar 5).„15Dr'. :•".. C I : 9' 14:5".1,1;t15"beis-ArrIa'ne 9f5F.115-1AlliMil Fr...III' ....,‘; ' `,:::.Il ‘,.. :..,i',., :"‘..".. c<Z' C ?,:cleic$V-5-5Ic . 5, ' ' Man;sd El I.4rried.84115¢y19'81ABLI:livOrted.: PATORA,:IN,l4t666 '''''. . ?..:::'•••: . ..."--.• •::::•-; .,.;"•;1:?I' T-2.;s:•7?;',•:.;')'!"i:::( '...: GIBSON.1:fr:;;;V:is-:::. :S-:::"•.( '..'x.."'' • P.)mo?..... ,, .j.-. 15.savving,Acoom's Name I -<„ -I `. •. % I, 5 .,-.•5..,..e....; .15a_<(If map»Maiden Neon. --II,-;-..-T J:.--55, ,tas.:::. .otriden‘te.Usual Oct.. ' 5 ;- ,17.,/GM a Buswessolot astrfir 5 10- . .I5 -'I, : `.. I, 5. t ' .5I y• . '-.5;■,;;Tr;-I55-'I"-5,..-'5iIt-•-: 'I- 77$,...r.:1,.77, :,->t.7.7•77■7:$;-7'..1:7,-, 3- N, 7'7 ; 7;1 ;5 '4- MARY,DILLON • . .- - . . ; S.:: ."-; SWEANY %' ..".: ; ::: c: i. ?-;:s, : LABORER: . - ' : . CONSTRU-CTION4: I .41 ‘s, ---; ;la:Resilence.-Stra:',- < ,' ,, ..,..„' I • -We County, <<„.•-,•.,.<,•"::" --,..i "... -,.., <Tab -"55. ::',1c,<Crisr: t.- ° INDIANA:-.5ICC "I I'.- I . . 5," GIBSON .1 -"‘:::, . . "4" .: PATOK.A ..,•",-%•:;-'s,;-..:::::W).........,:'''';:.." ,.., .,. 4-. ok.5 stem And Number, • . r.,5- - .: , .55...--5 .1.-2.5.-55?„,5i ..,.- ,...,.--,„, k 5 .?... -'....?,/ o.„; ,5;??, ,Ild Apt NO, I. 104.,ZIP COM „...,' ,la10444 CILY TI5ninrSI 7 :1,Tif.'5C.,;"! 5±5I;5,. i ' : ' ' , : II. '. I' - I. 5 II k- .:::' C. 1 i; .' • :I II/1 'I t', ' ''''.tI I . -' . 2:,.: ' liYillrffgoillti;) at: 306:EAST-SCHOOL STREET :: • : .. ••% s::: i,,•:: :,2.- , =.- ;T. i •Z; 1,._.,r;:..,.:i..,..: , ,I.::, -..'; ...- •z l'., : 47666 •C.I. 19 DecoenrsEducabon 5' .• 5-.5 .,.„, ..- -. 213..,Decedant Of Himanio Ongin..I.. i;,.. ' 5 -,--,... •I E21,1:Decedents Ram,a II)cp,;,;.5 ::5, ,: ,r :', I,: .." < , ..C.'-f ITT-',..TrciIII III: , . , $ : ..."-5`4II-CICI.*-J,E,:-......5".' ' . ..5" 5--<5,"- . •' It-,;.,„.0 ''S. ,' Jr 7 -4‘.7.,:i r-414-_-tkNizt,-,:f4.:5---.F,,,,,, r ., , „ ' • ‘frA 9TH.=-112TH GRADE;NO DIPLOMA ' . NOT HISPANIC;;.;" . ,...-- -.,. ,s1:'&,'":: `intl.- jte f,....,-;;;;:.••,,fC,••;•:::c.:4,•; ' ,, :-.;.";„„:,,,,-;`,„.5.$1,„„ ....,,....-....% 21 .: 22.Fat-era Name(Gm Midge,Last). II- ,, ; 5 , ,.;--•-•,, ,5 f• 55 23 mothers Name(FL".Hide.1-altr - 5;C.'`5:' , .- , PA 0:0TAIrs Maiden LIM TlameIr5 IIIII-,'I .,5 . o III::III-II555<.`5-:I• -, ,., I , . ' , ; • 5. 5 , .5 5. 5 5..;tit''. ,,cic,-,-, -.,,,, - Is -; .; Z I--...;:c. -:, ` 6.. t.. ,-„,....Thez...f..,-.. - -,-, : -... -,-, 7. -- ..-:,-.. ..., •,:•?.r,:_-::- 1:.,:t; •;.-t.--..-- > ::. ,-, --::" :i53:. ''' ,,,, `r• •d.s ii. ' RALPH DILLON ' • : • ' i . is. 1 i '''.. ; ' VERNA DILLuoN-; i ---...:;:: -;ifr : ;.-:-. MARVEL -,:'•::::r../.."•11:rptFZr r_ 9 24 Inforrnant's Name ' ,- 5< ,- 24a ReMbcoship To Decedent I.5,,,, 24O Wang Address(Street_And Humber.CW.i...State,Zip Code)5, '5" 5., :; , :...5.4„..55kWW,51 • ' , a ' MARY DILLON- -. . ' • . WIFE '''''... ''' . . "'''•; 306'EAST:SCHOOL•rSTREET, PATOKA, IN 47666. 1.2' -", ••;;;::“:. ..7int::' . ; -:: ....1-:-.-E..", :1-c-- : -.. .; . ... s. i..":- ...."-es, .."., .:.-.-.1 7.2E-"Ptae:of oi‘isilion r1 TifIt..:.:I,r‹,''..A.I:- . ...i'fibES"-i, . "7 '; " ! •-r-"_. ---258 Place Of cstn(Name Of Cemetery C.,mat,ry Other Place) 258 Locatol Cay Town.AM Buss • lal&kilt Carna.,0 ponmn D Ent.S.-an .. = i ;1' t: ,,-. i 5 ;:C;T: t :- 5 5' ; 5 I: I • • , 0 ei.:14(sPe:gly):../'' ' . , .. '• ' MT TABOR CEMETERY:: 't, ...," . .\, ..: . . MOUNT OLYMPUS;IN I ." 's..'....: t;i•c."-.11if:-..•::::::11) 2 i • ' 25 Was Coroner Cataded' 27 Name AM Ccc,plela AMsesa Of FonS Faly -t 4 - ' K.- - \ - 27a Fuseral Hr'.license NLS 4. .:::2".••• •.,46r: _,•'-rrr-ft ?.•••• ' 0 Yes.ca no , COLVIN FUNERAL HOME INC,:425 N'MAIN ST:, PRINCETON, IN 47670 . , - s : •... : FH83005671•";eilli.:41; •,.."" • MARK R::WALTER: BY ELECTRONIC SIGNATURE " ..: ::"...:::!'' c, -;;;• tt: :: -'"' t ': ,` -',•• FD01013010 t. • ;" s " . .:'";&;;;211L- ....•;. 2.1. ■ - • ;• 28.Pall!:Eetei'The cthLrgEC . ffrAi"-oesases:"thies;die,cmpriatau nisi biler'et.-;C.ailid TOr DeNatuk Os;H.&Enter Teirniwl EC/Oitta'.-...'..- . 5 I. ' ,' . • ' ,, ,",Interv4.:Oitie4 II• '„Such As Cardiac ArrestRespiraIcw Wiest Or Ventiaktar Fibrillation WiltulGlioviing The Etiology op Not A0breitiate;Enter 0My,One.causiOn r - ., 'I :Tdo‘-atti -. 'A Line Add Addtinal Lines tf Necessary. . I '• ' `,5 < / ....;••••5 55,'",.'T. .c,15,--.I,75,- 5 ,'" ' : , c- II:5 i::".■.$ '> ' Irricledta-Caase(Final Disease Or Condlicn Reviling In De;en) A" 'ACUTE STROKE c 5 i i 5 i y c , i ;L• ' r , , • • i, ' 10 DAYS',II, , T • :- . , . , . - .. , . I. !SIC I . . :1;.:: • , Seiduentialty List Coratione,'It Any.Leardng To The Cause Listed On 2. . _ , „ . .....-..., , " ,... 'map:is'.over,on - - ?. ^ t Line A_ Enter The Underlying Cease(Disease Or Injt.iy Thit Inctiabsd "4 C. . '1'552:I ,--;5'4% 7*77 5;i I.I I: -. . ..... ,.• ' 7 77' 7,7 5'77 7 777 "77".?;-:,,is();Ht - : .2' yEiTii-...:"...s. Pi : ; 77 7 '7 - - - : ;7.2, i ??.: . -, t- :,,,.. .; ,c•: ..,:: : i ::. i : - f a :CHRONIC RENAL FAILURE 55, : , 5, '.• .5 I - , 5. LENGTHY:o-II IlKe.5,,, , (I-CA1 Part Il..Enter OtherE4),,..tramflonamms Cnnollomm to Deatn But Not Resultrg In The Underlying Cause GMn In Part! ... 29:Was An&Ace's/Patforreed7 , ' -• - ;-,'I - " -5''5.:-,`";5,55 Nkt.,./ri , '''':. '`III I.- •IIIIC.5- '/"• :'. 30 We Auops Fidg Avalale To Comee The Case Of Deem? -•-5-5:• -,,-.(1 i- 1 IC• 31. pia Tobacco Use Ccerstarte To Death? 32 ILFemale:55„ ,' `,. I i. I I CI" c' .1.5": . -C.- I. 2". •t- ....- .'I 2.- -I I I 33.alma°!Dealt ' -: -- 'T.-'--, •T'If- 0 .....1.. El.hnnit1W.C•d.a 70,1;t•Prosnarliss Pnititg Mt.,.2 C.S.'!Oi :Da, i 0 Natiral0 ilOnigie 0 Arkidint 0 PelON I: .." °Y-es ,D PiPba*El PII°::°Litain : b;1.,.,:i..;,4,.....4,.....A Te i.v..re;:er:E;;;;:gt I..0:L=P:<,/,-.:va-ilii•-.,;=)i.:::: i 0' tiicce 0 Oa'id Ner'Be-De;eniiined ..5.I";II-...:::::ZZI... 5,1' 3: -DMA Of MART OAIWIIIII3m5W. ear)',5 ' 3E Tone Of trjury - ,-• , .f -I.;I 36.•Race Of Icon(EQ.Decedent's Home,Ccostmoido Ste,Ftestatrant VVoeded Area)5. • 37.trOry Al Work7 rrT.T1 II I , . ".-5,, .5.:"•:.,.:I:::.'n"z":'.. 4`..?' ' '. ' , , : • ' - 5 T I,C--5/:'I!I . , T ... .. , .• 39,Desmbe Hon Injury°cored 5 ..,. --.- ......, . I 41.Sip-More,Of Person CerofWg Cane Of Death: :. ' I ': 5",'5 '5,I„FL, ,II:I r•-... i.,:. -.: _:-.. 2 , , , 42.Carteer(Check ColyGne) .' ' •I 5:,5--. .TI-';',III ...-• • GERRY M:HIPPENSTEEli, BY ELECTRONIC SIGNATURE ::::- .: • N.::: .: -:.•:;-z' --•' "--- -CD cents:ha Pl*Idan . 0 Coroner .. .'0 Heal Mow 43 Harm,Address And Zy Code Ctt Perim CerttAng Cause Of Death: -5' ',I. t 5 it. I I.;r•T, I ICIIC ' It,55 :t C "5 % I % .I. 44'bete"NLTber .: 45'51,Ctir. ;iii:F,illi i se., : GERRY.M..HIPPENSTEEL•.;,-405 NORTH FIRST STREET,-VINCENNES4IN 4 --. ',:m"- .../: : .; ::: 01025674A,- : ..::.. .,-,,12/29/2 1 ...V.3 c ..„,,•• -, 4O.-Aoctocirsayters sem= .1-Tneer..,„..-'• - ::, --" -,....---- 't‹. • ::,•!...; .,;;, :1'.;.--,:; e.e. .. :,!,V,-:::- 1, :: ; ,,4,17,:"es; ' ...., :--:-.'"•.,i;:24,!ir;s::;"rit7le.-Tt!Ifirc-,,,, 1 *--&.S.:".'=:::..cr‘.- : \.:.,' -,`‘.:LI ! 4.: n .,. .----""c ir"'"'c'f. ' .:'' r..`c ',5?..:11-. : ...1::HRI'::;,-. -.:,• ...-, .4:At- .u: u ' <:,(a)-t2 i g:?-772:ii.t.5577.i.7:19.55; ,••,':,.A .48:„§i,gn,n,b„rai,i71.earrt,h97 -; :C.?"-•.,-" II'.I,'"c ',II+.3iI r5I.i-I ... 1 ;i4c BRUtE:BRINWIKVIA ELECTRONIC SIGNATURE ' 1" l .11 11r . :" Pti i lVi41lli'.."...&,tt!gisTalerlY•r,9:5,:rIrs'Ystr're-nrnt1P,Wi i3%>;.>?+;• }.4'..ihr.e:::E•1 . tr...4:i I:t":•.:DEC:•2T261.-5 hrs:,;..-ii: IV:#:.4 Iltr-2%.1111 at• "•-•:, .41"-..": ii:::`,-.):.':::trr.•?.;.::S:1,:s;:::::::::';';' ,:::::-.4,-ItS.';:-...:c:-.;.*-:: AmNPmENT.TPcER.11q.CAAPVAAWriirytv OR PRIG.D*14:::•2',.,:Thk..,- -.S.9 "..4::::::k-SSI:S1-.:."--, ::-.7--1:: ::-:-;5.41 .e ::::=-4.1ipc-Aiiti--;-,,:,,---11-, ..-2.:,,s;.,::-.::;:•5;--.:::,:c.:-..-:::;:k.,,,,,:-.,05k.!:r ilus--:,-,,rte,orv54tpuirifF.-..%Jupt;:-..;5:i itc-:;:iiii,--2"1,7" iltri7-2111,-r"-:---liv-ix?dir?r<1! , ,-; 1444,:"3.114.1K-Ly'friiNtIt---x-, ":;-,--,...--i-n-i14:iNntrN-,:s5:11Wziziliar-'-c444rlir4"Sik-,-;,-**1 t':•-",<C,,..--;<:.q4E-'scsi,re,4--:'ri4-kin.-"--" -t..-:•,- .:;;---:- ot,:epettr;zu-a lt,u-okuvz•-,•:;:.,:,:;---,:,---„--...„-As& i ..s.,, , : --,FA---.;:i.,, qr. litAvi,iiit. . ,,V111;:-/-z!Pe-;-:0 1 P-2-5:i.ri ""--;:; 1 --: 111}P . IfrOif .;="''' .?, T- ,Ifiv,?: ii- - i'',1iLftc,*;, %-ii-r - -il i Allif- .>1-fr ,•4'!; c 4 t-k•:. -.:0::.`,..,..,_:t,c-.-;:-"-{-k,fc -1.14-. E•:.:- If:4i, ' . Ir.(4,-•S'S----, .:1 •-;::_di -,.;--k'i. .- _ .&'':1 , ?,.,;-..;-: fric.-,,4,1wr.,-;.^:lp, ;.--..Iiiir:',"fo?....;:rti,i4F---25:iii,c,--11•!-i?5:11-it -: ilt ."-O'Ciii:171-rAtiidtiliftearilFrnticaiift:iii::W.it: ...-.-. tr.. ---311- ...i'7, -,..-- '.91 ,' E":; SLetiFoirn 53395j casiA:ft:..:Tbia 6.5asi ioai4-4 i•olikoglro‘i-esioa ofthpowywNwia wobboas,woy- 1 - DiscloSUre is wertary imd there vaIl be no penal)/for refusth.--....„, ORIGINAL DOCUM/ENTLITAS A ILIOLOCOLONED BACKGFpUND ON SPECHILIWIREGECURITY.HAEIEFTAND„, E GREAT:SEAL OE. E_STATE OEENDIANA ON SACK 514AT...., • WARNINSI'' ,, ,,,,,,,.er_...... te.,,,,,..1..5.,:&■..r.,_ce t OFIAN E, 0 YE 4 WH N' IIII, 4-:GRIGI Ls !,• KiEirr,./S IDD..‘•%Id D. FR 4 'THA' -EARS W/164 PH 4 4- 5' D-7?-5.-^liThr-ICTITVII4C.