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Death Certificate - Hale, Jack E_4/21/2016 .... „ -"'"*H '1141r" 't.t-f2.7.3 'INDIANA!STAT&',DEP •--IMENT;ORHEALTHitin ..--- :: -.1.,i'V,1Ts% -" t .--,` I, ti' a•w•-.-; # .- • K .'::-.k‘t NCERTIFICATE:OFDEAT.H ..: ---, ...4.„. ,. -Fe. a . ..„,„.• Vtifir 7,,,,,di Jr, -,;,-'1,I K%-:: r 4111 ,,-*Iii*iiiffil. frairIMIITIVIilini /,:j. -:-.11i 111:,741., .4.:t: ...5, :3-1R , ...%....ri/...itic;61:No,00001-2sts.cc-,,,EDR:Nor.000000490583s..,de--..s, statg,t46500200&... -1::: 31.'Decederes.Lep!Name.„(FncSeiddle,tastytioc-rettifffrxim7F.,.,.,-..„Ii:7p11 ;•;1.1a.1 tAZdr,N,arn,01 fe.91142-....S-Inire.I I iir...5. i 2.SeAl!q. '.2.?. .1-.91°IDL;'Deal it.'111T7i745Ill ‘P4r,:71):#1 1...[ ...2.41 .,Qr..,,,--41h.V.4.turF..„,..,--g.g.litil...,0 041 s0,n.-, i,.:... ., s.,:c all I t d -ellji.: 11,-/.....1J- K..,.i.1 t.>...,,...12.4 --.1111 ...014' 1 OACK-ELVIEHALE ..,S.':'_Z> S1?-1.t'. 1.3,, .r,-- -- :: ...h..- --=`,:-S.-`.. .1;:;•.---; :it:ISSMALE SS,109-.55 AM=.-. .-2=-... ./4..z.01/18/2016... '-,.."-,k; Faces7v 3 ,,tio.II Death Occurred In AHospit.V"..22.,.., .:7-,rji:Ij.i.Nz,•17.1/441.N thOal If Death OccurrectScerwherethfxrcjhan A Nosed,:1 t 0.2:,..;•1.:ii.:.;<..0 ti a.2..;:ijuf.1"5.1 I I r...4;iiiie.,k :,:;14:--:-&-rt-,z-3- s-zi- c.-:-..7,, ;;;-'s”,,...:-}; ,:(cfk-p:;.--s,:;cosz:::-itz<s.... s..,,,e.::i.s. i:Uri°aCF173-11C(S-151 PePt° '11'44-la I'rlY3ing 1-lan,115.ZSerrn gar'FF°k'Y S e* . <-02.&i..‹ Dyes 0 eir; ri 1.1-rincvin (al‘seent 0.Ernergencii beparthtentbuipathith.':0 Dela in'Aithal :brecjiit-27-4.7-t, !7;thlv‘n i;;-.2;',7;;;;;:.;,......CIS.::,1..,,,>.:11litt::1;‘.:S.- ..? ?,r.rt • 111..Facily Nam"(If Net Minna%Givafreeet end Numpecrc.-”, -2 3 7:" ‘.. _-:7,-;: 'Z.9•1 -."-:3.745C-7:14,,tf.A.th„..7_7.-;?,',4, 4 "re;!-,7-1.1:?, 'i .- ..; .-T 7:7•7"..2: :;-4y. 1-:;:--:;:.;,..? 4: .;1.: kl, 777-4 EAST-300 SOUTH-2,f/.2- .--- t--- .1, -1-,, :- -.: .;.3 ,:...u- - 73:42-.:3771:3e.'1::.'...;:t.:'. '4'12'c.:.tY°1•T°""'•s'aw:And..ziP Cade k ,', -4'. '''' 1 t ''.: '• ' "---'ii •:---•c' ••';r-:-=-' :"--tc-,4'.1114.92q," :: "•5:-:. i ;,<'• 14:t4an,0 ,t9-.1.-snirne9!ii,":",/4! 1.17:lij thic.-tfr:- ':. -/7'7: 'Z'Z''.A. 7..iCtz..... '..... .., ..‘' ':. ‘' '‘'` . 7*4 7 ::jo.,a':':"..-' •-tf... I ,'"•,....2:7,c3 V.4":37i;^ ‘..4. •{AVisg--„;;„0 ak-guest,I.---,;d .0 Dive,;.ae ., .-.:•,•;,4 /. •. ..Y \\-. ., , --,A .Ct-,S7,...:1?-1'. ':: --i'.- •Y?tti ,; ' Zii . --- • -----:". '" - '"" '• OAKLAND CITY?IN7660' -- ----., ,:-..--- . :-:;/;<, ,i/t)-,--../;ciitt„..%!1:0;%-::-..:.I GIBSON 7tITT,•"*-741:::::;:ifiVitt. tfto,"... t' -P YY.slate.ch. c!,t,,,,Y3filtd.k.PYiitinFilli IS:savithno.Crnne's Name 2 •,.,,,--,--• '4 7 • e t. -,,:.., „.--3. 15a..(.11 Wth)Grce maiden tact.Name .;-274-,s;r:,:"..t.: .4:16.'Decedents,Usual Occr:a:dr 34.1.r.c.t; .07c.i.gad 01Bth.thnesselnduszy,cealk 0 7`,. ,";"- x '-.; 5 --- -' ." '; 7." .,Tia'.---;•Zr It'?eYrC*C.-S-P'S.•;.":1>,1-;'; "tt.-7.7tt-t"-t; .>7',-77.:"•‘-`7:77:7-tS"..-7 - ktr":'971- -- -7-7.*:-Gt:k-‘•>:.-' ..:-.77.;', •-.7-, , 7 ' . ; ; '7 ;1"--..:7 i777. 'I< t ',7---2 . -a:t. " 1{4:.'lie:-: ii '..... . .:7-4 NONA CAROL"HALE ',.: - :-..- „:11.: ;:..; ;L. PHieLIPS: %,.t-C.---..,---4.11/E:.---- 111i--::-.1-•:t RETIRED CARPENTR-S: BUILDING TRADE& :0-jc .4.: iisf-Reli-ence,- 1151.-1- ;,-'' "1-,-- ' = "...Is'' 9?-11-"'---;----; -,'-::7-ft --1---i-,-;--/K 1 ,-.4".:19:9:2-r_T-Tr:1-,-\;:".s,'-'-:>-','----1'.:-,;...;'-.7,- li----t- 1;.- cf.:---=-0,.$*=-1-:;•;: .--z t. Icit-'faii'L„.%),It..;.-- :••'--,-2. ...et•-„.. 2 -_--„(a--21,• .7.;,...,42...--,...e, , ,:?;:z1.:,.. .,,, ---.4■7.,...-14k'...„-• t.,, rt-:.e.e.:,,• it -■-;,••1 •>•-ef,-,t• 1;: 9siNoiANA- - .,:t.k15-7;-447-< =; C-!BSON"..T;S'tkti-itSZlisiTtoot.'aii.f.c.•,:. OAKLAND,Clrf.Y.??jr&-tWr-r,i4af-a::- • rf<cz... ,-/<,-,4 -.-4::Pci-EC-r->ijirkti.14-..11-ta .e, le-c !rem°Numbt-,`-. ' —A' -r ", %:-. --?%::: •i--."-Cret-: .17Y. --'-f• •‘1z5-'...c-PS----Y'----T----:-";.,::27-':/-'"Y-72-i-;--- '1” AP.`-`19.-:%-.. .J`` ;2,t5- ..-c-,...?' 1-1-714:.;t1- -t-S,d-,.1-447.117.ilt 17 if-..:...vr-*• .2.1 I. .:.::-'., .;, • t. t.. -• -E ::: ':C, ii A : .t.:'h r?. .j . ;L:4 .::1 CY .t . SIIP-likc ; ? ,,P IiiS;.4.Ink,' ••-•:: .1 I $ 7E1 EA5LNosouTii-••-.4 ,: • i .-Th. 5.-i.2.,. ,.:-: _ .3...it_.. :.•,,, .s....-y.,....fi... ...i.:5,. .;•.,,:...i.z. ,. ?..-s• . -:: ...-!.. 1,-$47660::' ; •19,Decedents&Alarcon,t,./. i5,- 'P,,,./ ...I .-% 20.1X:cogent of EisP*°nu'''."t: •'.■.--7 .-I;: 01.77...°”"nts FlIc?'7illitt're i:,'II-J.'.•;•:::. '77277:•7-77:7-7E:t;:reti t':cit:t (Wig ,..9 -:: SDWAEtbLLEGE'CIREDIT:BUT NOT A •.,-,C-:.,1-7, -■::,;,=,*t,-c.4.- •,...44f..,...,,,,-.:.,....:, -:....*i gz-'....,<•!Wik.r.„c<-.5s,?::;.'-.--„Hi c „e z..;it:, . .s..., . .....-:•,--c• •.",cd.144:4-,-. ..' t•-, A ''. DEGREE;- ?A.'S-.4':-..,; ,r'1.n. ,/-1---1: NOT1HISPANIC-r--2: .-.-- : ---, .. ti..... - White.th--..-..s ::,-,;-•:-k<‘....,-"::-""‘. 1"----->,' :-.31,--.;-, -„,:;-•":-N,,-----/H-"=-'----:,:ani,.....:,,,) 1 -:- •22.Father's Name(First Middle test):, k ;: - ,' ..f .. 'I- _:,: 23 Mothers Name(Fast<Middle,Lap !, -. ' 23a Mothers/laden LasIName Aci.9..... .,-., jilt...7:- '‘e "7- ' L i •.: -.---. - , .- . - ,--. .-;:. --., -., • •;.-. :,- .,,,,-...,,,,,t,:-;:,..71-..r... „. ....3-„ ,. ,....s.• . - ,, -,,-. ::--.----; - .--r..,-..--....;• . 7."---):-.1-; :,•• • EDWARD EVERETT HALE : :- ..-. 1; ) :/-... . ;. 0,0. --., A-NNAIHALE di--::...k.:. r.c.1---: .;Alta: 1. ! "--- MAY - 2.:: . -..,1 r0.4-:-..t,i C, , •pt.Int=lasts Name.: 'N'It; -4i' , '-,-• ".• • 124a:Relgionslip To Decedent-.1.4>ter •2413:Maeng Address(Street And ranter,City:Sire 2,p Cot)`• '" th":''t7,4:4..gf.-,:- ',i C. ..-,,p.irect.,,k• -' • ': '7;77:cr.:: 7-.7,- \;. . t 7 '-.,• ;-..."; ‘237'1 i-7:,:kr:ft'-'71777.;,,...it" :Se.'.7.;c7 ..lfti.:::s.:*,dt..":ct 4,..S..,!Ti .....>-.. :-..., "S.I.:,...- 1,!.4 •i.z.:7:y.." , ,...CS.. 4C, ..:-... NONA CAROL HALEY..... r.,-----, - -1 --- WIFE - . r`c.:iii:r ::::-1, 7,7741EAST:300 SOUTH,-.0AKL:AN D-CITY-I N 47660 , ,Et--",:'-11-c.-="51-,----%/1■14J: I ;tfJ, .- --.5%--..:1-2-:---S-c--1-1---.'-;--------.:1.2-: •- ,... - ‘.1. ----.Z1t--1,..- .sc-j--: .--1S,Nc is71ige-bioliptaa-i1S..“?, VZ1Stf-S tfr.fok7 ft,:".‘'S:7",,,:t 7:77-7,'-4-774 'c„--7'i kr c".777: K•k•t".:4!•;;ECAlki Vat 7:7 ;25a,Stethoo 01 Oispolothe:: .1. *,;.; ?, 25o Flace01Dethdoen-(Ntre(MCP-metric CremathrytOtear pia") .255.1a1-,Cay:7JeTAAne State,._" t <7-• f,;: :.;...-T. -;:t..,-:,--z5t4-43.51 t:S a-B7"fo erencalancortio^0,81. raiht - • :-: • i .! 4... ta.-=',-2-Y -.??:PiV<11.1--;-- :4." 1 7 5 '''. 5 . ; , . ; !I „ . -4 : ,:.- : ,rie5.1 - bifi:;;.-tiqm;x'tsti•;<'5%: 'ref' •--... -- ..-'11-,',,...i. se: ....s..-7..„-t,i...f..-: ..........,sfier's/b.,-:-.* ' ..7, -;4.-t-,e -7::-7th- -' 2 % 0&r;gi(SeeTifi):%ck..1.5.. '.31.,..2, C,...7::,..'::-..4 AtKINSON CHAPEUCEMETERY211 .:. CATSVILIE,INT.7-i:Ir.,/ - - :1- . ;1-1 r....: ...;. ]?",:e :5 7:iT:tt 1 2e•WN't C?!."?'"-Ccers:C.91E.;s rf. 2,1■1tarage-A.d ccfreelet.5:grk,c)1,F?wal....7-. Fark.3, 71-4;-..a4CZ7...S..t.r. 1.--'CS':,E :S.§..4*..1/471$.17'N., •-.C.'.:7: -7r: 34.7. 7-)Ftt H9n-2.tj,re.2.....b,"ert$2, ...& 1 .i.,::4 '::4;T:.e.-,'1. k.-.. :::::., LiNMI3 iASIL1AM.MEMORIALCFRFELIINC:,226:E:WASHINGTONSTREET;OAKLAND CITY t...-..1.?"1?..::%--,'"Ii-r..--2 -1?-1,-:-/-i-ic :' .i.:AP...z.e2s.,i.9..21.6°-: ..;::::-...;:,Lc: IN12116604-4;.--al.:2,1k----? -1.--..c.,:tui‘tragf E., '0,11.::::::Q ;<,!..Sintits. -;:-.<111 "•::lkilie; :7 t7:::. :7 7:",77-..: FH83005312,7:41-F:ra, - 278'Siena:at Of hoard Final Service Licensee:it:tthtci>.;-:-;>.W.2',.... .-..7::,■l .7.--'7.!-.3•:9":27,7:„Se12:3:: :•-••77.77;:-.4,:t_t)•;..37,7 27c'License Nutter(01 Licensee) 74..7"-2172-IftC-:-;:>7■13 ;-‘12...\%? • JERRY BASHAM:f.BY ELECTRONIC.SIGNATURE.-4,1›.:.:15::1-----"'_ I -.1,-.----.1!:P°47-1,:-:.-. t,,ki....17.: E. FDO 16 8 ',....,4!.7C.,.. .til;C:r1...St: 4■1..C51.411:4 Z... ;• 1[....4 *............cc... c...-•;..::s-43f,....... .1,5,....‘,4yrec,:witX.-"'S'r< ,:•,-,14;.,:Gus*Of Death•.•(See IrtstructIons'And Examples)'...:„....`.-7*,‘V 3f1,,. - ',., 4'1;1:.,7.,1,x(..., 7.---Aild/daiiiiii,1.4;/,,,, S Or Compbcabecs-That Directly Caused The Death,Do Not Enter Terminal Events, . ' -;k... „. ;`,,ri..oi.1.,..„;?,-"arger,7,-at7ogetti. As Cardtat Arrest,Respiratory Arrest,Or,Ventncular f ibnItanon Without Staving The Etztgy.Do Not Abbreviate,EtletrOhlypneCause 0 • • .. Jr.-.....41 i-4.. ;To Death 1.i -, IA Litie"KAcia Araotital tines"it Necesi.iry.' ,72:a" ,S`.77. _ ..‘77-;tti , it„-Pit,.:47.ctrit"Sk„ tAalfs:{.-.7',7i4 ick.77,-;77:77trk,tt,„<":„.-•,s7.44„,!T,,t, i t t, tit- 77::":",?titTiXtcriner.,7:t.":"..2zrgt;z77,- 7, ,. ..--.7- ;7•7:37;•:"‘.7- 7,767:- -:7--- •7:-..Yik-77:tiiiii>"*ik"-'..-77; • 7; 1 t`t. '->. ,,.f: .:--. ' ..■:-"....#NS.. 1.....c.C:t. ..:. Immedmte Cause(Final Disease Or Conciliori.FiesutunitnDeap?) 7 K CORONARY ARTERY DISEASE t....-th ....”1 4,-4. , .P.: 4 - ', - -... t ■-.. 4 1 - - t,43/wiNUTEs AI. err. F. '-, - c .-a"v4-Wah.="'"CrrnenIL LI APR 2 1.,?iUltikrtf---:-. .[:=:4:;'-;---- •:;?--r. ?-;_.,,:i. .z>..._ „k:1,-- - . \ ” at' -7"7.'t':?t`z7 - :7,..;iti ,.... ::-■•■7?--,„.4,, 4cA'.. ,;,',;.:7;;t1: -k..- 4;:==,--4:k;'‘. :Atttc"st;;;„ryl, ...47; t=t. 7,5.: „t sequentiatry List dikaions;1 If Anc.Leadog To The cattle Lisle°On,•;777 ' 2":‘ ''' ' : ---"- ...-:--'..7-,---c....:;;;;;; "" ' --c;7-%..;:..' .;.,.."..:` - f:',"' ,,,,,Y-' `-`,-..-,•, -•'''' it,Ii .g Line A.':Enter The Odeairing Clusi(Dialase OLtripat That lt,litiated..f.z. I...: ,.... 4..... ;j.1.1.,Zr ti..---2ip`t:ET::::-1 ....“1 “ 4 ' 1':::-C:' -..*..c.11 t•"'"IttiF"7-.1!,....4. •,.?.. --:frie)71-6,9tif5„,isrilttic 1,,f4;PST.)tit::,;:;,-;.7":77‘.% -1/47'7<:,tt ;,:434 C..:.-3k,":177:3:::th., 4. . ., .7:774-.:,...Weethi7-:‘.K.;.14.••‘-.3.. :-.. t ....i.C: .,,,,-...30,4A-.4_,... ..., .?..,(4.,... 'V 4 .2t?;:; Fr ..r.:-C':11..-% i' .r....-' % ."- ; % . `•::: .r . ll'TC:;:ilt."'"% :-,..M711; IP=Zir-Z-.1-17-7,,,i-3,- _40,7- . . , .-•••• -7.t.:.: :f•:=7,priMic-,,5 1 .1.:•!"&-.-•.t•-••.---1Ct-?.-1:„-,:tzts‘ .'''s"---‹ ...'"::::. .-,1,.‘.."--c--, _;•?--. ..-c.-4.--"-- ,.. ...-.-;--E,-•=----4414tr-c---`14 - 4- --..--,..,-.1412e--"tV-.---1.1rf•GIBSON COUNTY'AUDITOR,t" rez:ZII4j: 14 Pat IL Enter OtnetieranC623(122m-Ce2 But Not Res In Tr111 Underlying Cause Gthtn in Pan i•t.....---II 23.1.th.ths An Author.Pen=lett?i we,' ;14 4,--iraw•,-.?,. .-ipw rf,:5'No - ',_44 k-a""Area\-"Alf>tCz1-4:: .---.. ."."441-:i art,----,"\•-,. 'rri.--`'4.,- . ,,111;c:relly .r..('.1411.' ...‘„7-4 30'Were Fandthg Ave/lathe T Carole:a The Cause Of Death7cAi'n-t'eA”,:-,-.",- 'r MYOCARMAL INFARCTION. . •' ;%;;,- ..".-•:-.;---:.+7:4*-3..<4-:„ -.".......--.k 47 'S:7,44:-.7.2-2:724" ::7,thz4.-4.--- -,,,:-...4.---- -4,--,..--thr..4.--.......-.4-4;4-4-4...thrthe it,:..Yes,:u:No'43 < '/ 31.-Do Teat=U se CorthetteTo Deathi.fr,- ;■--; 32.1 It Fethate:1.-;t.r ";:T. :1:-.%il; ?7.21111=0411.1 CU rf>,,,'gal;'il:7'..;7::I- '13(.!e-glcegYK:'-' -"21r.i,1N5--: rtf,--..:17aill rt,-3, II .4.,. :• :1;: i1_14.111er,c,....i, t5--- -,.... :0,...tico4i;v....-1...... :-0...,......,,....c.4i31.g,r,:.-i.e.a..7.isxe.co.i.ofo.ch n 0 tthea41 0 thonnacie 7E1 Acethere,LINT:fro Investgatcort,.2- ..1 i 72 0 Yes 40 Probably 0 No,t1 U.:3=mM .`.1-:,,e-S 2 - "S.:S1 4-.S-....-,...,,,,,>•...ZSie l • 7'<;:,:•;N:4.r.-.C.,-...;!“.-.C.....-WC;;;:, ,...-"--,?-1" -'‘r;•-•--,N.,,-.-,......"1.-.i...!---".:,‘,",e, ..z Flarill10 Cora To 1041414 0 than:P.7..1We.TS Psi ,..'-.....a LI Suede 0 Cage Not Ele Determined%.<1,04,,AN. 34.Data alf/jUly(11110frp,iYea-);-f, ''/1-. ;: '43.5".-1-1111e Of'Dory;-s',• -c • ':.;,-", ,36.iflace Ofillthry(EG t..Dcceeert,Nome Construe:J.:9 sea:Res.tataant.21:0,,,„...A."ea)-c4..; .37,1:..,IrttaiTiAt Worqi ilyi N ..i, -...Z.A_:•4,4",..c...2-2:1,..,f.(:.c• ,,..t..:-.- ^c.■....5:*("3 ."1.7:7:7„,..v"..;;;3-7"4.•4 ,,,..:.:T" :" ‘4‘,..‹...-C.:14, ;,1:;.: y-;14-,l-rnitijc..Z...t.^74'14F?t":1:44...r^.C.S..::::rli --..f;7•4:47:- ,17,1,t..-`2:--';;S:47-' ^" 'N`; i.'NI .'-":":.• ''.. ;.....; .:%; PlIft..-.1■1 -i ."....:"....111:Y-iS ...." ‘,Z1..1.'■":-SP;Vc■-•-•;1.<-%%‘‘` - ;SC'S"; ,r-St ..",-. ...':',../le......"-: -:•:-..- th.-4...,..- 13:Locator,Very t Sin.. - ..t..‘ . 1. t: ..383..Gay Or Tcwn...e ';‘4,4:i .:-:....>3.;• t,312111:.Smtd.. 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