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Death Certificate - Swails, David E_4/22/2016 z' t'r�n r:11 I i1 ("11� ' 1:0 INDIANA S r i -I ..1„C r::, R i ;lei eta .S �'? ° hstsc:I ',CERTIFICATE•• 'OF DEATH' f \\ �- `\, I I: ,.�) I la ; i rt Ili 111 ,?j 'Ii R I In�ll- -i 21,'I �JI.iI, • If .T'r: r s .y Deece ITC al N0;0 SM) I .�11� EDR No.00000047�7<0559`?_.� ex StateN 01DC I >41CC . f 7.1 DecsxrQe Le&Name-(FM MWk �) f r v � M� i;Ma n(Vam��emele 11lf'.iItr,.r jij Se� � .�ene a Debt: rl� . �xd r.trtfM :;v ..:,�C.,I' CL1 J ,.l b/ iL,j- / 1 re �'t t� .� /�•j t�;.;� ,�elai.:tEt 'Si - - r!:Itrlj_.1�': y L. --.bi'r A• DAVID EUGENESWAILS: r.-\. ��y .. ` \r,.,: > \ ti' . ��-\ MALE X11,00 PMT . .�:w�.'.`10/29/2015 76 Maetrs Da» .. ../ Hie l n A:e4Ce s�?f t\T09/12/1939>"�\\. DAVE NPORT-IAy� 'y- - r 9 `US Armed Form`Y 19.11 1LDeath Oaanedl AHaWital ,.'4 C(\ / rt i-r/ �t 10a UDeS,Omm.ed C SaTt.tn OMThrAHOSPlaS,- f I �. I j� !U.' p1' II• ":7,7..a7;;;: .±,� `� s �. C\�. \ ❑Hospxe FapNy'`®DawtleMS Hone U Nuury HateAagwml Care FaaSy "tic" OIL!'J3196,110 U_k ten U.DpGart\U EmeipccYDePanmaa 0a!7+ea+ U Dean DnAm+N U..oma( )\ „ \ I } Pad' Ih y ti/I a lt',Faady Name.11l Na tnstence,Giro Street aM Nlm:beU- > `• \-r jt,\� ,.y '4. r; F `1 - -c 't \� (1 • 110 N JACKSON ST - l 12'Cayd Ton Saw AM 2A Code- - `: - 13 �C�a'�anl.��'�O�1Deatl -i 14 MarWSIDSmAtisnedDeat E ".=,. 1i be Fr ' s -• / ts,', ";Q t' ,F -I r ®ManedO Mmned I a,,, -W O Dr solve _ ` OAKLAND CITY;IN'47660 ''. - ~ " - t. , GIBBON :� O Wtdared '-IO NevaMarted�O Unlaces tL 6-3 15 Suvmrq Spouse S Name .� 15a•N Nye7)Gry Maiden Last __ -a. "=G.Dereda ti Uuml Oca t : ' '17,-15e d 9niwssll,tlyxyC -.° e ,>� . - RETIRED EDUCATIONAL SCHOOL OF ✓ F PATRICIA SWAILS t . . VORDTRIEDE I : �tJIII�= INSSTRUCTOR 'TECHNOLOGY ' 13'Residence Stye a. ' tea CamtY `.,,., '- -- - 1�Ca Y/rc T - bl � -. / ;t r II i I G �� INDIANA ;%`"C :' GIBBON . - OAKLAND CITY ,'I *>. - � - ' '��.c t+.r1U 181 SSeet And Naier 2'- ▪ ? ; +.i �'1'/i y lad Apt NO 'Be Z.COde 1 191 Imcec%tmaj>L. ' /f I r t �.1'lT' 3 T ®Yea ❑Nj e II• 110 N JACKSON ST s ;c> , 47660 I .\`v. '\�YFi it 19 Decedent's EdvmSon s \ 20 DeadestdHispai80808 21 Dec dates Ram 1 - `'- .c i rY .; �~ <.`..;\ - f - '\ti ‘.„).1.„.....- ),., �✓�<,� r.��' t.,� .,/ `, < - 2 ^�` Y • ASSOCIATE DEGREE(AA'AS) ' NOT HISPANIC • r'i.� White _e . `? ri ' V.Faders Name(Feet MGae last t /• 23.MNouaxf�s�Name.(Fiat:Mlae•tasV 23a.Mot s s Maiden Last Names C f ;,f. < 'EUGENE.SWAILS ELIZABETH SWAILS.. > ;,• SCHAUMBERG i :; --III 2 Y-' 24 Inbrtnenss Nnme ' 24a'RSa,st.p To Demee:¢ Ar 24b:Matmp Adaess(Strew And Nana Coy'Saa Zip Cade)- f j a PATRICIA SWAILS . .•r' - - . WIFE"' . r''''-';': . ,. 110'N'JACKSON ST,.OAKLAND CITY, IN 47660>'.-. r =8 i .,. . �� � ;. -. ..\ �`25 lca,;dDitposiDm`11-- ..<- < - � - 25a Melcd d Demsta1 250.Placed Disposita,(Name Of Cemetery.Creraary,O'er Place) 25c.Lnm^..on Cay Toot AM Stab ' - • C i I r 0 et&iis O c:amew+,O Daamn.O'Entanarom • ' . -Y%I.1 y - = / ,' ❑Removal Fran Stye ., \ " \: - >% z. �,.✓ - - / '• �` s \ i ❑caw(epeay): •,'' .. + ., . ° MONTGOMERY CEMETERY...,,,- "= .•.-'% OAKLAND CITY, IN .f..I 1 •/ • 26.Was Caner contacted/ 27 Name AM Complete Address d Fawral Faaty�.„Y . -'�'y\ _ vs' 'ham r '-`�.. . t . 5 27a Flneal Hane License NaMer: a > §r"\ ®fes O Na IAMB BASHAM MEMORIAL CHAPEL INC 226'E WASHINGTON STREET OAKLAND CITY ._ f L -' 1„ by ' IN 47660- •-- '• . . FH83005312 N I - . f s : 27D..Signature Of Inciaa Snare!Service licensee .r . - • 27c- License Nana(d Licensee): • �- y© ; - JERRY LEE BASHAM , BY ELECTRONIC SIGNATURE. t. .' FD01016589` r I'` iRT.G , .• •...,.'<' r ,.\ yr Cause Oy DeaN (Sea lmtxvcltmsAntl E,<ettpesl <'`.T. ¢ Appmma:au� i 28.Pan I Enter The Cham d Eve t, -Diseases bjlvies Or Compticatian That Dreary Caused The Death Do Not En er Terminal Evens'. , Duavat Ome` Such As Cardiac Arrest Respiratory Arrest,Or Vereriaiar Fibrillation Without Stowrp The Etiobpy.Do Not Abbrenate Enter Only One Cause On TO Death !II r A Line Add Aadaai Lres d Necessary t > ..1.3 c ; : ? 1 c '`ti' ._tt a T ` • pnmedate Cause(Fusel Dsease Or CoMton RestRilp In Dz.. A CORONARY ARTERY DISEASE'a 7 • m ..cn.gse � e ��, ®5 W PK � ' c :. < - lid ! �I Y 1 SineA Enter rTte ndemi Hans, (Disease rI sy Th LinedOn B ... a. ro c.�w.em r r 1 ,r $ L'ueEv Ether Tto Underlying g fi Deat Lassa(Disease Or DY!+Y That Initialed s s r t /,.L. 5 .The Events Resu'sg Ina 7 Last: C '\ F• a APR`,. 22, , - Y:�-< r i. 1 3 Pan II:Enter Oiler Sc'r ,tCasi Cattn.o Dead But Net Reuarq In TM lMalymc Cause Ginn In Past I 29.Was An Autopsy P ,J ,r‘• ,• NO - .r-T S e ■ 7, ' /'• .^'� 30.Were Autopsy FlMVpA� . .PSp�(.el CasedDran7 Yes �' ' l' HYPERTENSION.4 ` �.. ;' �� ; \ '= �❑ ❑No i g• 31..Did Tobacco Use COs i&te To DerM,. • 32. If Female'. 2 -' GIE;iYOrte . ' - TY AUDITOR :T•• a ,Yes ❑I?mDaa ❑No ❑Unwawn O ramp.tve.,rr nr O P47.•14,r ate .O.,a r:.pn e.tP tit'C m aa.- I '0'Newel 0 Homicide:.(Aadela Perdng Invveaapabn 1 ' � . : O rww•a.a.as np.i.a o-nt r...e,a.•ore, Q.re., mr iwv.,ir.arr i • •O Shaded Cats Na Be Deaminea \: • -3a. Dew d lnnpy(MontNDay/Yea)y; 35.Tuna dlryury - 36.-Place Of!nary LEG.•Decedent's Ham Cantumon Ste,Rett LSalt WaoedPree). 1 37'Wray At Wtk7 - I" i }� 38 Locaamdlryury Slat 38a. CMOrTam n 360 Beetle M.iber1 38' Apt NO.:- 38d Zp COa , t.7 39-De reQ04IrHY'da•+mad \ ' \ / ). / t S k...ti ❑ O �r.rs,.i Oa..rsrhr;\=,„.r -c re 41.SIO+s ire.:Ot Person Cat+yinp Case Of Dern_- • .r..:::1 5 • , I e 42 Cent w(Cheek Only Ore) l i . ' t bt STEVEN WAYNE ETHERTON , BY ELECTRONIC SIGNATURE:. k t>. '�'.. -®ca48krcPhi'Siaan ■ O Corona: O Hea"a-1mr •`-&-t Er° - 43-Name.Adams AM Zip Coded Parton CactyYc Cased Death: ^- 1 . .' ?: - - • M.Lase Number 45 Det petit.Wil1 i• et STEVEN WAYNE ETHERTON P O•BOX'266-0020 W MORTON STREET OAKLAND CITY IN " :' ' ? : :I •1:5 I ': - R 47660T-n.t;:"..-".-:,'`' `° ..- - -_a .-}' \'.. -� 02003011A- h: 11/03/2015x. ; K A0400mal-alaal-enmPNS'Ma. -- : 1` v T I<7,:Akan • '1.. ; 1:�.f 11r E •\\ti S ;S"''.-4.1.:-. I's. v '< .y, 4' .- ' v v ,' \ :cry. .-. 4 .- a _: li%¢:,. '!/ . �-.48 ,?3tae a tml HeatT OU.mr-5fdl' y4. i ./:,•>r T r fl. >yf; t r 1_ 49 Fa Rrep1sin OMy Due Fled(MOnYVDeyIYesT rig-�y>\\y?\ A,U BRUCEBRINK'JR ViA ELECTRONICSIGNATURE1. t' .Mille.ti!1 AI.:$� Il �<ll 2 r,f ,.-S c n I;s-NOV 04:2015 .,' ,:Y/'!II'I,4II)I L Y i,E-S i ;E`-?r \s�,(;E\�rYii\`1"\ 'T.',,ZZXAMENDMENT.TO CERTIFICATE OF.DEATH(ENTRY OR ORLGWALIC tTS��\\`4`\\St ur;T:b\ctc '\ :