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Death Certificate - Enyeart, Kenneth D_4/19/2016
' Ve--.3ANYALC-a.t.h7ste--3.1.004LC-TOV:VEct3a.Sti-'="ifle,c3.1,0.ral- / Voz.3.195.01 ' . ILA ALLT7s-afT3.13:21e,41laotILCorle.3.3,,,coLpuest-sisr_Nem...moentoo.„-str4 , IP "r5;•'n:,1••••4rP.-- I 1 <I1 „,idirr-.: irr--- 1 INDIANA'S,TATE DEPARTMENT-PE:HEAL-THAV- :;:l. .irv----yr.r, , -c .... •.,....._ -. ...,,;.., CERTIFICATE OF DEATH 4&•......*".tt's .. -"N. '..."'t . V/ -IL. .:11 -1, i I= .,,J41-.,..2 I Arts.---1 , Efircimvic-;;-?!-:-. : "t 4-It*II. ri, ,..-11i, ;.9.,,III: -• , 1 . ;... .,..0 ,..2- . --- - = t'..---4 ,, a - i.---f:' f..-...-c.. ". ' a.1 • --co : ... .4 ;:..--H, - ", --F. "--..-"•1 ........ i .:: 01:3666::- .NL \.,_ ..,4", , \--=; :".., Lcai:No 000549-_,%c....CCC3ZEDR:No 000000502485' - f .,t,--1-:;-,::::::state:Ncis: ... ,coder,,r.s Lego tr mir,e.haag.. 2.. nw.....4191.-,nii:.;..:i ,t Ie. Maiden.Name lit tem") .•, , '. ,• 2 1.,..,1,.i re. 2iirmirja fcitisr.. jitlith!„..!Aorf...,..Meri0 41 WLii ,r-..-(411r-7,44VA ..„ 1..,r. •ir-az„....r: if.----, • KENNETHIDEAN:ENYEART - 7-.., ..4?;-::e2; -- . . . ‘MALEe4.: ... 140:45:PM4 §':' art.0721/2016r . ..?..,11ii-'465r4i.4:7..m;;Th;:..-IM"f;II:CPSI •,I. Hun ... .` Humes 06/1.041930'....t. 441 lOGANSPORTilN ..-7.?...-f...02:0:2.24&4 1 :s:,Er' U S'Armed F 7 ti a 510:If Death 0=xted In A Hospital:r.--,': ' 10a It Death Occurred Somewhere Oiher Than A Hospiallitc4..‹..^1i;ir...-^<0fr,.;,...^..()%i vstii;E.,;",-ijiliFf;441 II ::'- '-...W:=4:4- '‘.:-. .;&‘`Y-:,;- lf;e.---‘,>`:1.z'-.' ' 0 Hospice Eecity 0 Deateenrs Herne°. 0'Wining tionislamrearo FealtYrO2.> *;:t4 3...• 0 YeiCtirNO I 0.Onkriovm1 .0:I ra;terit 0 Einergeecy Depahntenibutpage;nt 0 Dead on Arrival 0 0.,,,,(speedy) - - '•,' ft-1'P' ;,.?....fi:*!;--:,1 1 rtrY-4.. -C CV53:5•T■!3 ,.t-,,,,41: ,...„ r..4..holett,, ,,,,..of,tifer.. hor.,--...iiti.E.r..ffl,ce--e.Mr ii..0 , gii:Factgy Name lit Not InstaSoon;Give Sant and Nurn5er):31::9:.- z:. 61-1ARLIER:HOSPICE'CENTER4"..=:. 3:--- -," , • , % ;-.,.-:::-,:f-it,:it. ...n.:',.. -2:1 ...›..-:. ,.. 4: 1-cz. •■ I 312 jartyrTewn.St"And ZrPCoded it:::;-gg;:E"-1 ": '.. 13 Canty Of Death '. %,„,■&/. tl.i433ln-4SnlAQ121?&De . i Vr ..:-1: '44 I ts3.-01.1e5K.::::-c44t.--4..4.433,C..<.::::.--7‘3,"-c/ J.'\ • ' - .„c:. 11R)hrinied elantedlUt Separated:::0,Dkr‘ceea. S.,. I i EVANSVILLE;;IN,:47718.1---... .. ,:cr-L-,. • (-:-. . VANDERBURGH ...._.. ...." :::i %;:. :13*.%;f4II1P ITIY#111#811.?Igt.11^Iinr2II. /.. 115:::Sureiving Spoeses Name^,..--k .t;.:‘,.J.:.•.:.:-.;--.:....- ...]?. ISa (If We)CHe Maicen Lag Name 16. DecedenTs Usual Ocapalion..-T..C.Sret..F. .:17:•Kind Of BusinessAndunyrk•.:5.3.,.z..- „,.... 131>al;.;11W.IZW.01:S.-ri''.;.fs..f,','3 '''. "J;'. i ; . • --.- ": NI',--;‘,-;"1,-... 3Vri......>•-•,,,.:443-.-.Z.f.3*-' • II36.... ,. ...to: , --...-if : f- ..' $':-: 1: - ' DELI4ENYEART1*--84: 1":;c3.:,i 4Z:-.--..t..-:::lc 5.-:' :I ' KUNKEL BARBER i t. e •r:-..._;!..--2-z4..: BARBER -:-.:44.. (4.:5.,.1 18a V CoanY • Its Qty Or Town " INDIANA :. .‘:'-'-,--.i.-•Til.C'i-S:c3irici,VP..3-{rThr:54.%Pe.-7-C:f.i.,CS'42'. .5.i, .- Vie3ffir, irr.....,1tfr;;;Id;c-,C1:;,:.,:.1::: - ..n.k.th ' .*:■r--''' :5 '.33iir•51,i,(,:i,C,I! .', 3,1i'i.",41.4i),;,,,..,' .{! S..I.-a,4-■4441.112c.I.ISi.?;1:::::4: GIBSON ,• • PRINCETON -. .I ; • icr'-:..IIR(.....■-.14.-S-11k-,Af:::lect.cc■kt.,-,ZZ-C>...tiaSz; ,,* :18c 1Syeet An]Nuillbeti•r,:••••.?5 f it.22:55■ft",.22252;':k.:-Is,::j ?. .. 113d Apt No.:-5 =IBC'Zip CO:le L,h-.;: :18k:inside Cuy Lirrats7;:. .;4 ;?‘..;... )-:-.1- . :' ': , -...; "%.:..,.1 -•-•,-..;1.,hri.ob.,, ,Iii,c-;:illu...c.;;z. .1....., -b t tt 7-$7. t-.€'1,474 •'cr...1?. INE1 Yes..iip No 1 1 'Z'..,' 1281EASPMONROE STREET's--- $:-7.- :- . • ::::- -IIIIII:= ff..§47675'. ''......n?. .;c45:-.-S.t..d ''' 091Pe5Fienr 1 PuC4C^-I E.C.Cti l 1 L EfiCtirl'E.:131,:'11'7:::::.. 29-9T3d!"!cn HAPanic Ng° 21. Decedents Race -.:, ',/,:',;%-.:.-32:1 ;i1,7r.,1;..,,,ill;Cf>.,,,qi.,t.,.mir.5-?;:61 HIGEISCAtibliGRADUATE6R,GED ..I.,•Lf-zI-z1:4, .--.., ' COMPIETEDig?i11{0%.:11IIN:1'7F-C III; NOT HISPANIC VVhite • ' 'x.C.4'.-. ' -7",:‘$*\144"7".-Sr<LI:t'Mtsi,alt-OlY:7:11SHtIC.N . ''. ..'c'•:.-_. t:>?;7-if/Q>.S,;7:17ifelticWitrgt--:".t:r5 „111 22,FatherS Hanle(FIrit.1.1•Cte,Last)Allt :7',■r5.„,::: .1.-S. 5; . 23.Mothers Name(His!.Midde,Last) 7 ---- :T.. - ,ri; -•23a:Mothers Maiden last Name r..3h4.;•Ti., 1,1 „....-',-1-<2.3.3 ";;---: -:.4---2• - • •- ',5T-cli :2.;.23- '."- 3r..33:T.' -P VERNAI3ENYEART-ZhIN.22.2:::: :,.....; ,L r,_;,,,.: ; : MARGARET SIMMONS .4241 . 2:-.eit 41.-.:(.6.-1 HAYDEN HI: , :::41 -22%.1 • 24:In:cc:art s Name..,..,_ .,•-•Cir C......,,-,W,(;_z-<,V.,,,,,z,:,•, :.',:- 24a.Relations/se To Decedent 24b.Mating Address treet Arid Minters Qty State;Zip Code)3c,........%1Wti..,...S..... te.3.is...; <3.-.3...51/43.4.-.4E- , 4 • 1-11 .;.11 .1%3153 ,.''-`: -.....i■-e,<.:::;i3-.."' ,,q .:-7". ". , ',I.T. 41 CELINENYEART2A,II.Lei I:127.:::i.... .1!Ii....-4 WIFE• 128 EAST MONROE STREET;PRINCETON:1N 47670,1iY4IIii:,n5.7II;; :i C„u : Stgr..:■,... .,.."Ca`-;;;I:.,1 $ -.1:.;,,-...;-,,,:-...;,4,-t-,,•,..-q; ,,-- .,• 25.Place Ot Disoascial . • :4;$3;Z:Tf.3..:..4`,...Nic C 'C.::■.3fiC.S%:x-VC.N.:-"I..:>Z.' 25.e.'Method OlDisporcn r.-- ! c;.i,.2.: iire.jag, ..„2".1,1 ...a Disposition(Name Of Cemetery:Crernasuy,Other Place) 25c.Lccaoon-Qty.Town:And State..;: ..;;ip.e?;r2.. ..4: -:,: :..ii i,...;-..; i v. ;#.: WitUrlfCr.heroC56;11.0 Dona"0'Eregmbmern '''-■:.,:, ' - ' : %' p,t.. ::'P....- 2' , , : r....4 Ttce"..: r .triCegAri'io--,;;III-1>yqcf;',,,y4.,.,.._:---s....,-"•:-,;: i"; :, _ - - -,--, - -r- ...,--.--...-:„.;:-.:;„ .- --c-- . --...„, -• ,<.: ,.- -...--. :- -> 'arb,..•,-,:;-s.:-_--.'"$,:tr' -it.,,>-'f.,== EoriCi4=5:M ::ht,,PlInc-,-::1 ST4JOSEPH CATHOLIC CEMETERY PRINCETON, IN-,,,:......-%:-. : :=%114;i42%241i1LOC.,t1.-2:-:-.1..di-52-1J:1,72.. 7t! :36:Was Coroner Contaaeats .27.:Name And Complete Address Of Funeral Facifity :Z., PiPi .:31113W>3-::;.:1311. • ;TIA,tfli.W61111:::-..,..1:. • r :.3.'.0.-.^1 i ',...• ...r.C.4.) .31,:tr.1.;;: P.P Yes's.°N°P.""ktgrj";<r4f DOLVIN FUNERALADME INC,425 N MAIN ST., PRINCETON, IN 47670 •.:.. 1 i.r.s...4:::.4=2-1 :.....c.: SH8300567.1.2II:II....,A1-c<vcI IT -.S.",..1!...::1/4t I rfic. ' ....('-■ , ' 27b;S9neare Of Indiana Funeral Service Licensee; --,•,;43r4 rs-ptstt.. 27c.•License Nunber(Of Licensee).„,::ats,h:;■. ,,,,-,-,,,,,,r,„-597.-,.., ,,.'s IJOHN,WWELLS:%BY ELECTRONIC SIGNATURE - FD01009940:%C-:!IIW,:illDa.."&:.11:it-fr.::!•::!-.4%:..iP%X44p-L. -.,, _ Cause Of Death (See Instructions And Examples) • '-c..ciw .c...Z,.....:... ..Tf44 -r.....-i:3-4-of7i,a;iciiii....z.-4-c.,•;-$. "... 28 Pan I:Entey ne:Qhain Of Events:;Dikeses?injuiies,Or Canhlicetions-That Direay Caused The Death.Do Not Enter Terminal Events • :4 ,,,'..'.-5`;':;7 jr,...:T f ....1.2_, ...5•;.... ...:::InterVaI;',phiet S jt _so Seth AlCaidiac Mess.Respirator/Arrest:Of,yeraticulir Eitwilaticn Wthout Snowing The Etiology.Do Not Abbreviate Enter:Only One Cause On :' . ::; '!".:3-il:I.i I ---.e.,Gt" :3'.1..it:3-:1°I:Skto.;!it:-)...k4 ■-.... A Line teaMarital Lirgilf Neeessaiy74. .tkr F.:::-....i... .z;:' -::4-.TrliTirT."351%31r,:33.N3--11S-. 2.-r;--`4>r•-tfc, ..thr.,32-3,.. :-' Lamp:hate Cause(Final Disease Or Condition Rest}ting In Death)...:4W.....4.7‹.r.k..).1g,'...-:tYie,[5.3.41,115-,i3,2k47-3:k •.,'..,,, .. t -. ' -:.;-?4-.-.3.3k - =. '`T ..34:kr.-13-...`- _,, "cr.,Tr-S3:. -tr ;Si'''. :3tn-i'''...."C-3* A. RELAPSED SOUAMOUS CELL LUNG CARCINOMA WITH BRONCHIAL OBSTRUCTION 5.::::1 :1'4%.% ; -:::::•..1',..:;-.1 , s......; iii W.c 1B••B Co••••••••OB II- •53.,'4;Br:N.4 5:22.S.•••"reck!. .2e.,33;3il-f.:CtIci 37.1.-VI ..... .....:`,"..b-- ".--.2 .7...../".. 't7"...:->.-7F:,15:`>?.•57.- -.• C"5:. On ' • ,.1--2,..,"-•S ‘C.23.....-.`"••-•••`,I"r".2,...,"‘‘..±.'''‘.‘‘'\"5- ` •>•-••• 7 -7 9.3-5=•';- •5-2.1b74•.."..2-.7.5)....•:•ri".53„.--2 1 55•CI.-...t: :.,”.../.:, ..-r,,,, 7 SaqiientiaPy list Ccikktmons,Itt r.koy.lAisi4:10;To The Cadse Listed B. ,' Line A.E.,Entei lIclUrideihring-Cause(Disease Orttniary:That Initiated i , y...,....•,........., c„..a ,ti.„Ai:5,...:,_tn: 0...?„: 13:1,4:i.5.2„.1 0 i The_Evthi ReVuttirt.bYDeath)1:a ;10.:7::.*-' C. ' . .; ... _.: 411',.47:-:-ta:s•r.c.c.- ..t_ -1 i f • he.tormAceseraoefr...T: ill -::5;..n ("21 Ir.r."-ltile 3 h...‘2..2' . pr4", • 1, 3..15c - Aijr":***C4' e;r5t4.tly.,4a4'%&71.4115:- .1'17:....L.2.:::..!. '. . . ..-; .■:..4-t If.,:4%4..4?Ne.11 ral5L37:Ci1/45..S.H.: 7t:\'5 L,:el•S,C.<1".■'I?r.i , .`:. / ‘7,&■....N:5,31, o-Z•sl: ', ;(,. .4-.C.A■.- "SC -'.C..‘,. ..."3-':;:.+3 , D. 1 i pan a,Enter omer5ki8c!eatconsth But,Not.Resultng In The UndertiongpR Gr 9P71).,5 29',13,3 tP"°173:1:.931.7331.e:nr?.411... _,iti,"i;;Iillifillidil.W.:111r/l{hr. .,.1.; , ! r----25.41:17,--0.121ira,234.wcp:ap;:-e.:4:4Lcr,--- 1,:-.:... -- ,5 '..C."‘il-sim4:::--:-...,. . 30.Were At.sopsy Fins Available To Complete The Cause Of Death? -•ij rj,s-tc.•;-:.07.-o....:, :31: Did Tobacoa Use Caltatute To Death7641.1A-fl:31.It Fe5,aiel;i 5.f.I, ' , , - 33Aanner°1De.aIIIM7%.:,F.W113/"ZilitSgicRSHI an K:ali 5?" ll I LOAM IF-/X-Sal I 0th AYBITHHC15•42.71 Bonn 0 Progoo AI•• •Dom •IstArkiCrp•H•co yam.C Dm a 001" 0 I5.IZIBI b 11,51:Olnicides15 0 Accident:0 pending InvestigationA-.....4 bit El 1:113Z3n.cnn,IP3.25?' ;,.-03.i.trfrtiZZ;;;seto NT.%Inc B••t .: iI •-:-C.Prn•••••Vam The Pomo . triViCrdcetti:b=7•124 13e.DateCriliela-th.. ..zisn....-- E v•--!.e:Nr.-19.0-...cirr,-0C1t...r.A1 5, .- 5 • I' ,j '‘' 34 Wasp Intry•(M°n2W9t"Vaal,P7;(-1; .135:-'rn9'"trY' GIBSO elitIt+TWAtiOrttf,et"Hcime.CanMn°n Et!;i3eirtaifftiVZirprAreaS••41.•P:02z4'1)1(7r:F!'''.i-"\-... ,....'ye ti$N-',1&,,..::-.4r-'.* 'A..;=." ---- . t 4.k--c.....---e ,:-...- -'°--.- • 5,..o Yesse-.0 Nast7-"t77`r< f. I ihs_rso'hisso2.71ht-S'.775:rLit'bisorto.......-P h:".". _to tt-J:: !? -5 . ' ..?'2`..---"":31.7 .7e.Ste '`..,sh "---...S.a..serissri,tc.'•/7•->7;,tr • 738thsrx770"riwY:Sk14 C .--- ii ri.7-';2:1 :38a. C333F9.Thve, 380 Street&Nutter . -' 1-';:1 . 1'.38434FIK°:75..C444". ta.3:14‘.:-Itir:CaS/7:'... .3:41t;r:•<1.".kiii-;:li 31- k...-t-4'0 '" ›-i3.... -11. ,1.3:':.."'Ai.31.•rx--1 ,7•,,,:k ........3 ri-,...:-I-Tcs.,- ' -... ----,-.. , rzi.. ..,..1 .... - :..., „J.,: t• ,)- . 'rt.:.:',..1 ;. :- "5,-;:rf . -0.,;f:,:.1, ...:„.5, -;.i.-r .,..; 39.,DeSMbe HON Usury Oc.-corectgji13..,,alls.ai .,:i...5f.:•■A• - th If Tra3BOOraBOBBBIPIY52-?.?-4,:iS2CCOC E 7;45:•-•"-5.re2.•• •: .,I.-Cr h.:- -NY."*.32::0•375"""22... .C.-c- -‘,r..;:..-;3-‘ . 065•••••PrOotiB`•-•9•51LIB.5•••d:IM7•raect•; 11t.r....f.tl/fIK.>$11)Z•2•7;a•Ortiintil'fib-•e.7.41-,..:. , . V.HIL•r4.Frt:' ..! 415 Sigrorcr,,,01 Person Cen4ying Case Of Cleathql cal Eff...■_:‘•,• §, 42.certoer!.(Cciric Of biie)Klccizkii r<114.1f-tr,c4.,,;15;1C,I.:,: - C: .., ' :JULIE.WIGERHARDTBY:ELECTRONIC:SIGNATURE ra cert....4yimPrrylidabCI Coroner..k.%, 0 Hiathohcers*&-71:7:-.• 7,-437Name:AddreSS And Zip Ccde Of Person Ca-dying Cause Of Dean::• • t -r 4.4 7 License ttlirtherC-C,i: -..:.; F.45.Date Cer.,fied!.:i 17::.. 'Cr, --,i-..'i h•"-3:54 •::: JULIE.KI:GERHARDT-It600IMARY,STh:EVANSVILLE, IN 47713 ; 01057271A0.--,k,t>1: `a-.103/22/2016 >,s,,,, ...,1 - •,, .',Ada-tn#Funeral sinice i?'....17115eraiiillise.:%T.•11 . : o 477;tAicas;i tlfes;ij!is- tti 7••7.777-airtetitri:1*, all •P../... 11-'3,... 1141.9.92.2=7e9r.,-Triir3-24warrird ma :: . . ROBERVKENNETH:SREARi4VIkELECTRONIC SIGNATURE . . i :.....1 .:LIQ:l-a-.4-s-44. 4.4.4ke..".. .4. ..._ .4■;...' t.:-..-:-., e N. 49 For Reetrar Clnly,::D"fitel iIMccitypgry5):0•42%41I Fr.!: I . .•' :::::-.4.4411C2.:14141,14A-.Fir23'2016t1111 ./C4fIMMI2 ; 21.53;:a., 5751-,..5 ,5-i.3: 15,35r-,.,.`,3,53•5126 .5""y„II55i"....;,- 27AMENDIVIENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) ' ',.:....N.,-):?.11.;3".:7;ertakit-.;)?,5Tfirl.:cz:.`1,33;31- 6`,.." ..,:: t im r..,....:r..,:r•- WIW,ClAllpIrl:II>:.-fr ”1.r. - ' ' ' ; "Lezht:r11 2-.2.-- 11.44- .91 w,,' piercal2.22-54,a4 54 7 7 , '' .I, felilwala%01.9:-S.Frao i:1;;L ory[4.1470 - Da g -420-1- ...‹. r›-.4 Sr: :ca.. ..--_-•. :Ilttr::422-.2. 2,I : ••• : - -. :2:t-%%;;;S.:,- k.,,,,...4%-: `'' '‘..."- -,,,, "1„.' '''•7 ,iY-Zst12/4I''‘`'‘ • a , t. z„..I-.c......:1 ., c-,,,, •••.;„. ,,:,,,.1 ' ..-f0Lik tiII-0.1.: : ILcaizt'I...cI II.,- t:t'....-:: r. ...e.17>101.i7n. -,1 t 5140.5torrot...,..„1339ATTEN..11,074 ES/WE:J.1Si SS'S SeCihtyrt.i.Seitiitretclueited e7V this state agenCi in order to pursue respoosibrlit Dlic...kiiiie's.:vriliirtjtjar-iiiii7liejketia.1747-nci pin-WA.;jticpotria.idiMil?5: ; 1 pi----r---,-- , tr%WthriAL6066MENT:HASA iA6LTICOUDRE6BACKGRO61■ID ON SPECIAL 1.VHITE SECURITY PAfiER'ANDITHE GREAT SEAri0E2T111.1i0F:INDIANKIIN EIACR,THAT, ,.WARNING:r.th :- al HAKTil RAS FR.....-0.____E•TGYELOVSPW7lEN RUBBED ORIGINAL'DOCUMENT HAS HIDDEN VOID ON FRONIVTHATAPPEARS WHEaPPIOTO COFIEISCO1 I ii-51.1.--rell ii z:.7.1-COT;i3C