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Death Certificate - Donohoo, Bruce W_4/1/2016
irst ---- ------- ---- -----;;-T-..------c-,-------------- --'as-r:-."--- -:-,-----; -it;-----;-- -;‘---;------ .----•-""';;.-_,,-"-;.;4:::‘ ..,,,or,t3.-.;WW-Piti-7-.1j, tlii 9.,:;,,Iir,141,./.:-.:Z/PIANA:STATE•DERA,l_ , MENTIPF:LHEALTH: 11. -,-;,,.v,--:Iiii w 1 -,11!F„....iiii t.„---.\-„ij, ti...;% ,....,, ti.j.":::-.->„1.-:,..:".1; 4.:-.. '-:::::$'4 .4,:s.,1:-:„. k.-..`,. CERTIFICATELOFIDEATK, "- • st& 1,2*----' ,:`,.. ti":-. N., --..'''''' ..1 Nlr'l st,',,11,, Aift,-;.,:-:: fi, , tirio.fifr: 11i;f-111M.-ciir=5:iiilr4ille",alilfir iv.--Alil 14:1401 - 1 'li k 1 i ( t 16 tit.* . &C.1 I FC< 0075a i'.--tiN&.--i-fk.1- ''''-- -; '-c7 000000441504i ----,..g' -- 016628'' 7W--1 "<„---4Uocall■lo; '= - Stsa",:-..-fr§:`...74.5IEDR,Ner. _ , 3 i • . .i.e_413_N,i; "3":3-- .StateNoz 2 ' . e'ssz L.L:......__/ ;),,,.:1;c1Feci,,r(si-tgamr,:crint toad!.,:1,-.51.:0ii-T-cf-;‘;:f--m-•:: ;:% • Ii.;,3,1,,,,,,•0.7icfry"):f.%>.to-,.. Hirt.fz'.se.;,..-51,;;; ;74,1"9P',,..°',Dta5v:-7,734'i :"'"Da'e.C;;!PeCiimurni!9aYITefi'7 ;'-"a441k:Sb '.-.'&441.1i:"L'IPJi '''.ailLik.E.',7 %-'11:-.-J "-;IT.-•,;1:-C-..41i t*,; ,,411:,-'44:<-1:11AV*--'esiMr'skilli=a<cl r--,,,,4,:li,-C/..0,144 pinZaeA441:Sti ::.>":7,7,:: :/;:- - :t.)...f;:-.s?",...;‘‘.S.ti:-,::MALE=., '-;;=,:;.07:40-AMI;›,-, •,:rfz-1_ 04/02/2015,-... a. 'Is' ?,,.#. SArrnedlocces7W AIO•LI Deaai Occurred In A Hospittat,, 77,,' . A..' 5 IC:-..7.7;1,77,1-;,, .1Catlf Reath Occurrea_Someneere Otne.27,1han Atinsel 1,-...,---, . .,.-- :,...... c ,, .. -: ,,,,,- tsinTI -7,4 -(1: ,#i,.':..:- .,1-,::?3: ----,,, _Q.:c...;,._ ::<, c-,„ % ,-*;:cwcc-...s-0 go-„,:cio. :0 D.a.--a ,-;„cii;corhirslig)Wa4-liGnCireFacf:Z,;41-4,-;,A;j:f.t ) t...La.Yei 4 EINo r 0 Unknown; 0 InPatient Iabroi;gefitit-PeParanirt OuWster4,D Oeizi d-rti Arrival riett .--Ady)''"• -9.Cntr, " '"5.oCliC2.. • - ,• ; --7 . .7 At.`0-....7:., - 2'. ')Th‘.• :--.. HA LIEWHOSPICEICENTER .;: ,. -R: ' ,:...s. :3- '-.f ..i.S -.': ..-- :?:.: •,--.-.::.: 5.. :7 --; r 'l, 1 :;"'S :. ::::#%t L: . - : i"' i:. :: ral R ..,-*%.i.;,:..;:t S .:.:?.. 'rd'ir>2..,..dr: r;; ?r-i,-: • 0 mAaci10 mehle.Ells sePrlilS'Ilr-13 CEa6d.. ,.. Si' VANSVILLENIN1.477.13 t ) . :'-'-- ,, :.:.-1' iit't. .: VANDERBURGH:•;:. -3'"'••••••pit. .P.V‘itl4fied>.c.1 tie'imair ' qt...thit-9rit, Ail 15;,, _SuMving Spouse's Name C.c., ....,',. ."- . . ; t ; 15a.111);Vde)GNa Maiden Last Name;.‘.;'S:•".,"-:':'. •'16.,Detez!ent's UsvalOccuption # 17.!CincCIStrstnessAniisry ‘14'.,.:r''".;9%!-)t^:"■)?":11.-C-''''-;Nt T ' •- ', .: '-" u4'...CAJKANN:DONOHOO . . - ;. • I , `.. KROEGER: ‘:% i.. --:: : ::, -, CONSTRUCTION - •- -- CONSTRUCTION : ----.! STe.- • 62.INDIANA' cs ' ." . ' - GIBSON - ., `•:.•••-' ''• ELBERFELD4-:. ,./.fr. _ ,.,, zr: 'i ::•. , ..• •-•„---, •••.i., ,c',•: -,...,••••• ,, ,,,,•7.: , . .t-isc SUeetArodNumbet r•.: -. , ,,r,--.;,;:.:145"6.7-11,i71.1,1i...;-, i „ • , i I 7 t.- 7.1 •.,... 7•7, .''' ' - '' "..;2 5 ..2 % ; -..' i .C.7.7:,*147. ,C • i....-11 %C.'-.....;1" c St .7" -•"; "".' • '"."d. -2-0 Yes:0 NO ..:.•14 77-Cdt4. tifit'.1269;SPUT171,900rci,ASt . , -- ; ' ' ', , , .%,.1- .3,-, - 1.-3----,;:3s.:: ;:.:-.:§f::::,.--Z.--s-, •::-•>ti*::-......,.:::-. :••••,:...:47613-,:•7.-: :::',-,fl-r.-T .cli...5. HIGH5C1f1OGLCGRADUATE OR GED . - -• ' . ' 't•-•, ..'.k•.„ .-•-' '"c: '•-111"; V.f,'cez•-.1•71-ttaf-••• " ''', . - , 0.-:: , -COMPLETED '.") 7 ... ' ' . 1-* NOT HISPANIC- : , •:•-•" '-. -, ri White . $t -:. s : r.,-:` • -.. _ ... 22 ranels Name(First Wide,Last) t t ' . -7 . .. . .',. 2 M e.-4s Name(Fst Mck Last)t I 23a Mothers Maden Lag Name ' t i V.- .:'' ;''' :, : , ■• S■ ` 4' ■ , „ ''PAUL DONOHOO • ' (PAUL : ' : ••::. --,:5 ' THECMA DONOHOO ; ;, ' :i•i?ti : WLLIAMS : , • ' "-. ; ,!f ?A. ..,1.1rdorrnartts,I7lam!' ''' : ' '' - 24a Rele,onship To Decedent 7-- ".t 7 24b.Marc Adnress(Street And Number,City.State;bp Cone) . .,,," •. , • SONJK-DONIOHOO ' . WIFE .,..- ' , i -c ......'. 9269!SOUTH 900 EAST; ELBERFELD, IN 47613 : - • . . :3-.:‘-•:-..-3•0-.1.t; ...- -; -' --1 - - ' ' -. ..e 'z• • '-'. "7.-- .N_ N. i .■7:•25.7Pia-cd'Of Ofir3OicsenTSC...73:1Z7:Ce.Z...-- ; ..:::.;S. ' : -: '7; ''',t'icS ,:t77 23a.Metl.,o0 Of Orsposzecn - - 25e Race 01 oisposibon(Name OICemeterY:CremetnlY:O.,11fiace) : 25c:Lccatco;,.C.rty Teem And State . . • El'ii.n. d!O'Genie-Jon 0 Donaeon 0 Entombment t 7, t - , A !fc,....? 5 .7 t , .,. . 7 H7'7 . .. . 0.Rerooval Frce,State 7, -, , „ • 1:1tb' f(SPecrlY): - • .. ":. TOWNSLEY CEMETERY,,' '----.-,.••-r 1,1r•-„...' MACKEY, IN .' 7.7,-. ,' • 26:4Vas Coroner Cont=ee? . 27.Name And Complete Adorns Of Funeral Family , „7 . -. 7........-d -....- :7,4 .,,- '-;'N- 47 A '- : 27a Final tire Linens r. ..... el tr, - t. • CORN-COLVIN FUNERAL HOME, INC., 323 N. MAIN ST. Po BOX 278;OAKLAND CITY,IN •:- -.s•-<:: -1---“. , : - •• • - 0 yes' E l Na` , • 47660:0278 ''• " f T.: 'r r. 2. i t. . e r''.'.‹..d. '... :l' . -: t J 1: C.1.441t. '7', ' H419400002'; . .7; t, • 27e.Signature Of Indana FLneral Service LICOn50e: :, = ? , f • " : -: 'Y ..-% P-. :f : t ; „" ,27c License Number(Of Licensee): ';;;-, -: MARK RANALTER, BY ELECTRONIC SIGNATURE -.....• :' :- ... I ••:-...- fr,-, -' 11:. ti . '.--, -v-- . FD010130101 '' • :- . ' c.--:• .-‘(... -.." - .e GauSe Of Death 1See Instructions And Examples)e'S t-St...N.S.intC:N- ' • itt, ''1.77',- '-‘okiipiaiiEtWe ' '• - 23:Part I Enter The Chain Oi Events =biseases.Iniries Or Complications-That Dire:thy ClUsed The Doti DO Not Enter Terminal Events - C. - • • Intenta•Onset . . - . i Stsah As Cardiac;Jest,Respiratay Arrest,Or Ventricular Cientation Wthoin Snoinjiibil-neE,t,iolgy/.4s....tDO,‘Nztic:Ablxcizi..!nal ET.rtlY Onf?,;,•?P7°rll''. l; - : ' ,-- . • - '',.'l c, •:: r t . To Death• . • ''.A Line c And Addainal lfries If Necessary. . A. . t-Irriniediate Cause(Final Oisease 01:Condition Resulting In Death) A. CHRONIC OBSTRUCTIVE PULMONARY DISEASE';:- :'•C • ?; ' .. ,. • .., , . ..`7.51zip lir =' i,A.c,.',',"tef•°I , . NI -Sectuedeilly List Conditions It Any.Leedng To The Cause Lisied On . ., , , A, A.., 0:. c...........00 . . , •Line A.. Enter The underlying Cause(Disease Or Injury That Inateicl ' , .„,, .....„„ : 4 . ....A., -..... . ,-.., • . . A„,v The EventiRdsuZing In Death)Last' , ' C 'RENAL CEEL CARCINOMA .•." ?". !.d •.- ' ' ' °Y"0"."'net'04 . -' . : : . ... ; 5; 1 .". ■ !, ' i i ; .. . . : Pan g.EOM,Other SKabcant Cona,tons oontnettyna to Death But Not Resulang In The Unaerrying Cause Grvin In Part I -. - ; 29 Was An Autopsy PerfOrmerf?,. . ' d y„:.,.: 6•,.ic., 7:: ,,,...,,,t ;: 4..-;. ...cc. ri V--,'"1:1- 4 ; "-- • " .- "..• - i tit 31.Din Tobezac Use Caumetae To Death?. -, • 32 11 Female: " ' 7,I : t 1::t : . : .4;c1 ' %':':5"5' 373-117,""Pc c't° 8°T•Ti :'" 2:- 711t1 :"71■" .:7', „ ."• ._ I0 terr1:grul Venn Paz,You 0 ftn;...e At ore r:i o..., ITheei.4,....e.4.,.e,..tne.,■2[4s co On.< rif ffairal 0 lic:Tidiae ;0 Modem;0 i;enr7mg invesogauoni . . 121 Yes u Prot:a/pry 0 No Lj Unknown - x . - .0 1401Pmrani.ButOrerynt 43 Dn.Tv tv :, 0 V ' TI,P.■■Vow s,". •,'r 0 Suicide 0 Codla Not Be Detedninea -.9.! 34 t Oa*01 Injury(McntaDayfrear) - 35 Time Of Injury •. -•' Place .., ( ,0 °lents Home;Gccsrycton site.Reratrani.Wooded Area) 37..1nray At Wor157_, , ,- 0 Yds 0 No.: g 15 Location Of him-State - , A. 17 ,. , • .' A R ;- 1 2016 , t . = : . : , .. - ..: - , : - & 39.Descnbe How Inrur/Ocaarea - /- . " x ' ' = z o....,,:s....., 0Pwrce OPecesnen OCterIap.h) • .(. •!.a .'lt., 4 L_..,a.: -".::,. •‘•: :s; :`,: -- ".7.• R41. Sl9tature.Of Person Cendying CaltSe Of Dett' . -. Vs,I 'err -..."111.. 'C 4 7%,2).„.:.., 42..Cer4fiel,(GIX.4 Only Crre) •' : - -. .:iirlf-:.,1: -.. ., ::••;,.: or.-djOLIE.KiGERHARDT; BY ELECTRONIC SIGNATURS.I. ;-:.:-. T-.18buNICOliNt`l'AUliltoFi'L-1-% . ‘0 c''A'fing P6Yslaarc: • '0 cut". z '•0 Hee"Itr'SLks''sk".‘"t _A• 43,Hanle.Aactress ma 2to Code of perso,Ceretnng Cause 01.Cleatet ' ;. ., ; 7 ; 7 5 -it 5 -:--": . 44. License NUMber ?' .45. Date.C.„,of?e;!...r.. fi .i i : . : .- r ; % - -- - - . .. .- . rc ‘tr .Ck--'c'%) r r 1-„."JULIE K;GERHARDT ,600 MARY ST., EVANSVILLE;IN 47713 -..•: 1::--,-:- •,-' - , . ,-•..t.: .-••••< - , , 01057271A .- . `..-•C4/-0-4/2015 ‘,..3 ‘ 45.Addyonal Funer"ai Sentice provider: -.-7. - ''' • '''" ' -'‘'t'L". ' st.7-"'•,r•"" ::(..''''';';''' :' ril'at'.. 1.2.7:".<:" "47.7....).‘l'asz. -7,„ I,7,•,:.'rgi.0 iti,....<:;...>?...i.,:e:&:',R,E;"$;,47:•.;C::,,,-t : ''>,,A., ' ';■{ : , . .;,, '::!`s';%•-: :"."'...c......:r.:-...1.-7. i".:41....I`-dc.--..1: . ‘"-- .:-.-- -:-..- ir i-..3c..".N4L%--i._-..N: r...,. 3.:._Sso,C-PPI,1-5ca'tLeamP, crar ':'--:: t. r %',r tic%,.; ir--i-,.,"r,•-S,'; 1 irl.,- - ; - 1?..1:d= ;-:: = IfIt.f-7.-1, :49,31Qt9tgis=,r9?1,Y=9,Fewl, .etiPriPpria?rTriEd-Clia:If ---;c:Irrl ii,..--5_,. ROBERTKENNETH:SREARMKELECTRONIC.SIGNATURE,1>gt;iti i: :c'-'lit:.,-c-IlEs: S.',1 '1,-ct,•::-:.-.:::,...;•:::>_:::••:i'AeR 072015>2••:- A --...-24 ...,4:,,"5--1?...k.f -. -- -----,---N-s-ir N-AMENDMENTJOCER11FICATE OF DEATH(ENTRY:OR OFUGINAL),,. ..77.. .V...,,S),,A”,... ;,:,",-.77Sta. s. :„Cili .114,•',472,7...t::..1(3c2,C ;CC:i 7..C..t....: y 7... :••■:7C-:,,:. W.i.11i' .7:4111.5",7{..,;r41 V.7-., ....1.....s,.<. - ,s.,,`. 1.7.:A.. `‘-t-ZZ---..-X°:--C-77- .•Q'k.-.ji-S77.-cc•tt,0r ... i---lril-re;dicirr;;:i.---S.:;:lrj3".;:-",di- ...;' i . ,-,:.5-2 ,,r;-• ,..,,„----;1-r,sk.--'if nse^ZlirtiiAi i‘- " t,,;•-r intt,:,e -?5; j--C-.:%11112-f-11 -::-> t..z.i,-: VII 1 nt--q "-9:Atir*, :,"-5---.)::,i'r,sr,:.■(,:-..t.cia-.,.:--0814,4ii <1,1r 5,fuh. *;t9;zo,ki,i, -,- ec:izt:yty:c..-zu .-)Ly,,14-,-;1? -•,,..,,...- .-, .,,, st.e- ..- '.-„::::z) sz,. 7.--::::-..t, -- ,,,,....., 1*, •;:i State Ficip 532.957...e..12.ENTION ESTATE:Olio&tat Secrity" tielbj!iiiitiisitin_Cy,Itiii,sird.e:40.1i.cyliSbibiiitfi ktArrinYiaSx iiia,datii1V. luisti4yo).thtfirjr.ikip„.tiithi ierisrecertioptifigiqtatietaiallll 1 - Icid.bRIGINA12666USIEta RAS/.MULTICOLORED BACKcihDUND ON$PE-CfArdWIIITE SECURITY PAPERAVIitE GREAT,IEAb OF:Rg SIATFOFINDIAN:1(01V-BACK TliAT ''"":::. WS& WARNING:t. -- -•la RM: ETOYELLOWWHEN RUB; ditORIGIsiiire e 0-1.1ENT, HIDDE1•NO164$4 FR•NT-THAT APPEARS WHEN RHOTO.,PIED.WCI 1:`:L- 7.".?',.:1■:;* At. .-4..: -........ ... . a ..... -. ... .... .. ... --- ...