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Death Certificate - Blackard, Sarita_3/1/2016 r t tin. I �- t Cf •': ) ,' I I I Y wl )'/ Y J!", .r a v ▪ I �- INDIANA STATE DEPT T • 7 OF,HEALTH „ 1 ,, r 1 r Ll,y P C �I .. i � J t Q v)� f< x I •rr>+,e; 1N �. :. .4,t{f 41 3 -, •t A. <•. �,, Y „CERTIFICATE OF DEATH' . , ; `, a _" ``` �° •s. T ! y✓1 tr ar x J 1 / >/ n1.. 1 n Jl r1 -Sr` `v> -) x111 IT i d r�� I,i I:t/ l i 1 -'▪ I▪ ITr (I.i C/✓ II„alt rl"/t) 11 j I 1 1't% I r (I ' ( IF 1 5 ,.,1 �°Local No 10017.78--:=;- ::.“.:s:-' . EDR No 000000220695:` !° 'ir 'sate No 041854 Fir ' I- 5; t DeadersL Nod. MAee last �' ta..Matlenhiams Dltenae)- �I 25et 3 Tmeq DetR 4 Daa OLDean'(MuciDayneag .t ^' '"l 'A -)'•, r i -,^ (l..c i 13>� rl' .j �.ls'.r i �,w. L •. 't 1 ✓:"r� ,.;at SARLTAABLACKARD '-� a"- ` "v HENRY- k`;,1 -7;.:,‘.:-.;:,=:. :.-,./`" FEMALE. 09:25'AM .'09/22)2011" < • > 68 �..� Maas `+t wys_ i'._ i �s .. 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'y C 1 1 '� T -I: 4 x i 1 C "• 'III ALLEN R BLACKARD - " ._ s I - ' ACCOUNTANT OFFICE MANAGER - 19.Reslderce.SMn £ - 1Ba.':Canty -b..<-' r i 164 Cdy OcT \• ; x _ +- 1, : . 'T t INDIANA. 'O'er ' '__ - GIBSON _ - . FORT BRANCH 'S "•••••• i .s _ ,-.1•:•G. 1X Snet AM Mmba- ; `, ' ) • < . 164 Apt'No-,�%Z y 18e. DP Cade' stet Inside City Lints).. 6345fSOUTH 400'ALLEY EAST _ r - i. 47648 ; ,-O Yes"®No• 19 Decoders Eausaeon r -< 20 Decedent 01Hbpelc O,i i =:-,r 21 Decedars Race r.' - 5 BACHELOR'S DEGREE(BA;AB, BS) ; NOT HISPANIC "..,-•%. White :f - `x ."' ,.. f"` Z"'` C: 22 FaMh Name(Fat Mee:last).; , ' '23-MoS s Nane!Fast MGde,LaW 'F " 4 23a MOlhe's Mar last Nane l ERNEST HENRY. x 1 - I . ALMA HENRY , .-: ' t KRUSE •"-- I ' , y 24.trlonvm's Ha ns..:•�t - ,yv,r 24a RSaimattt To Deaden-` r 244 Ma 1Q Addes(Strew AN Manor.Gay,State:re Cop) ,. `a ,K,,,;;i •'- ALLEN'RBLACKARD" - y""' - l HUSBAND- , .> 6345SOUTH-400 ALLEY.EAST;FORT,BRANCH,1M47648 .431. s''- ' << "G -:a _. 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FH10900013 1 ;271 Sigetre Ofllrlmn Firma Sayre Lianas ? -�`-' t'•:3t y i x•+; 27c.Llanse Nlmber(OjImneek- - ✓4 ROBERT S STODGHILL;BY:ELECTRONIC SIGNATURE : - I IFD01024378 ) '< , 1. ,< ,. �.._..r • .,.., '; . :.- .�„`Cane.Of.DeaN,lSee trtsuucdom AM Eaamlres) -..< -w..-.>' - _a Appmdmapae `28 Pat L Enter Tire Chan Of E'vesas^Dimases triunes.of Canpkai That Dreay,Cau&C The Deatit Do Nd Eraer T&nuta Evtii-= rT . watt Orna Son As Carcase Arrest Respiratory Attest'Or Vertrvlar Ftnttaim Wthaa Slwaig The Eulogy_Do Net Ablaevvte.Erier ONy One Cane On - - '.To Death > ALite. Ada M tna1 Lies If Neces-sa7. i t \ i. • `.c tk t. ; Immeaan Case(Final Disease Q Ccitlaren Relating in Death)s I A ACUTE MYOCARDIAL INFARCTION'T ` ' = ▪ •DAY ' B To Tire Cause toted On 1•.B DIABETES TYPE 2 > - .�' YEARS- -, y .,LiWaGaMr.The nditms., Any. (Disease f.. _.i ,4 - p • .I / Line A Ens Resre U in Dag cause(Disease Or hyt+y That IrWn.ad E d - ;,✓ . 3 < 4 The Ever"Resudilp Desd1l last - .2.. 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'AMENDMENTTO CERTIFICATE OF DEATH(ENTRY ORORIGINAI): _ ♦ - - G a� ► � I1 3o- - 0 oaf ©�3 oast °n ti Y ;z�, iv z: - S ' - r� .- ^ 4 i cal< ,��� '.mac t \ t i.t ti > , i t1_ r c i L4 'III: y:ct, .I'i'Y._ 4: 'zri}.s -., >:-. F _t �i.n.aa 1 `^r-i-t _-:lL~/=� .i s 1,s _:) 1 .741 ▪_ .4c `y: ?a�� . StrerFam53395`yATTENTION ESTATE:Te Soots'sec yA n 6eitgr qunnaby Bm.aatOtagerclaotdel..topaale1OWO�lslldilyl DEiiosaes.;v0. •at Owe Y )be talcpetm6y..rttttia�t} I� litta WARNI��1X �I *i^ HASAMU�T1CO! REp BA(XGFmuuhr ON sr314D SECL.WOrf IP,FST`a GREAT,SEAL Of_THE SiATT'OF l3IA &1G1(7TL,T"� NG TURN FROR(�ORAAN TOYELDt7WHEN RUSE a iiGIMALDOCI1MEJST HAS HIDDEN- a DON FRONF'THA•APPEARS WI 'PHOTO COPED IS1-."'�1:vI".,aY -:-,t.'I..-TY1xN^zl\'^tL-tVn .s' t--t=br'e.0 vrA—,.MITr-AWtem%tWt-Y - . f-E,•T1!Vk"--.cTTJI-- xl£'9L t:%r-.^Ml eW1StI1MNr'[SiZEl'