Death Certificate - Fuhs, Frederick M_4/29/2016 JJ -_1-.GS"J!\:c:ildYL'JG.b-3Y..Vii-`f-'.'-aU.I. y_'t,-- Y:Y ,d•er-v...a�-a...;.v:...v-s..r- .....-..,..v .._. .�.
^ - ' P,, :!.:ir•;,-•:.'i;i:i INDIANA STATEDEP TMENT OF'HEALTH' 5q !- .i '-•
I. " ` CERTIFICATE OF DEATH - 1
e state No:021757
es `5 Local .M OOOOSO EDR la 0000004e) -, i
t D,ceMdys Legal Name(Fn1:MMtle Lest) y� 1a Meidv,Nanw (It Mpae1 2• Tme p Omni _ .:.
FRCKFU � ? *- -- " t -' I '
DMHS E ' , = ` ' MALE 07.30 AM 4."05/0112015
Armed Fumes? 89 . ;lm. ItDesnoerarnaas .r.oq.rTnan�HOeorq!: . - : - .
9.
Ever in U.S.Armed Fares? 10.n.De ej Omlred In A Noepdal. - .. ❑ F+ ❑Decea.rs Hmw ®Nursiq idmaM1rrPterm Can Fedaty
pares" ®.NO' 0 Ur&O*r, O rcesO Eti ewe.. 0 D..a ,wn p os5p -I rt rwer ' ' , ,
1,.'Fealty Name(If Not Instt ,Giro Sn end tl Num3ed •
TRANSCENDENT HEALTHCARE OF OWENSVILLE, LLC • 13. Canty Of , ,a..Nama stm^urine OyDmn -
u.Cps/Cs Tarn.SaA,AM Zm coit. - .. : _ I ®Marred 0 Named as Separated ❑!r ed
.. GIBBON. ❑v.1m..d,...❑N.raNanad'.❑unu,oan ,.•
OWENSVpousesIN,47665 1$8.(nWde)GiveMas'LassName O ,e. DeadecrsUSxdomamun 17 KrtlOtBamas'/IrwaaY,-
I5.-.Swirvq Spares Name
REXING FARMER AGRICULTURE •
KATHRYN FUHS • lea. ,m cryarwan. T •IS Resianu Sate ' - T. , .
- IGIBSON ".- �
INDIANA . . , FORT BRANC Jam,Apt No. 180. Zip Code Gry�Llnitw?
lac. Street Aral NU.Mer
jh - ®Yes D No
5635 EAST STATE ROAD 68 ' . - - - - - • • APR•• 14"9 2016 I 47648'
19.Oecedenrs Edra'dn 20. DeCadem Of HStpSlc Onpn 2t:Decsderus an ` .. .
HIGH'SCHOOLGRADUATE OR•GED ` NOT HISPANIC White n -•
COMPLETED 23.M,p,eye Name(Fat.MS0 1 23a.MOdrls Madan Last Name : •
•22.Finar Noma IFe4 Mbi LarJ- ` -
CECILIA F'UIBSON COUNTY AUDITOBRAHM•
•
ANDREW FUHS .-
2a.lydo'meRSNa-- -- 24x,RammshiP To Decedent 243.Ma-\ Adtreas(Street And Number,City.Store,Tip Code) .
KATHRYN'FUHS' I WIFE 5635 EAST STATE-ROADJ68,-FORT BRANCH, IN 47648 -
2sPladaohpPVdm -
25a.Method,Of Dwouton 250,Race Of Diaposimn(Name Cl Cemetery.Cremasy,Omer Place) 25c Lccatm•City,Twin,And Sax .
'.o Bvnal D Cr noon DDaaxn D Enta,Omero - -
D epee m (Speedy): - ST BERNARDS CEMETERY FORT BRANCH, IN -• '
2J_ Name AM Complete Address Of Fat Finley _ - tie. Fu+ad Mane License Nmaer.
2B Was Cams Contained? \.
D.res 0"d, • STODGHILL FUNERAL HOME INC, 500 E PARK ST HWY'168, FORT BRANCH,IN 47648 FH10900013
-273.&retre Of!mere Funeral Service Licensee 27c.license Natter(Of Licensee): - .
!ROBERT S STODGHILL BY ELECTRONIC SIGNATURE `- ' -- - ` F001024378 - .
Cause Of Death(See Insauctbm And Examples) . '. . \ Apptoxvnae.-
2.., r. ;�rr.l OL E erU.•
-Diseases,.Injuries.Or CompIicatms-That Dvectty Caused The Death.Do Not Enter Terminal Events • - Infant Onset -
S8 Such Enter Tie - To Death •55 Sudi As L:ardiac Arrest,Respiratory Arrest,Or VerOiFisai!Urination YYehouA Shoeing The Etiology.Do Not A3revlata.Enter Only One Cause On
A Loa. Add Addainal finest(Necessary. - - - - -
A CERESRALVASCULAR ACCIDENT . . 2 DAYS
Lo.medax Cause(Firl Disease Or DondAwri Resusiq N Dlafh) suers r•c.we 0e
•
B. HYPFRTFNSIDN \ SEVERAL YEARS•
lame A aEnt list CmdNdra, tt A!A'. (Disease To The Cause Listed On _
•o..ra r...caw°w
Line A. Freer The Underlying Cause(Disease Or Very That Vacated .-• SEVERAL YEARS
The Events Reabrg In Death)Last C. RENAL FAILURE
Cut.lc.MAC• W ,
0 CONGESTIVE HEART FAILURE' - • ' • SEVERAL YEARS
Pan II.Enter Other inI C"r`n'"'11 n e ra.+In Deal BM Na ResUUq In The Underlying Cause?Sin In Pan! 29.Was An Auapsy Performed? ❑Yes ®.No .. - `
'.. 39..NMa AuOpsy Faxing Avadade To Complete The Cam Of Dean?. ci Yes 13 No
ATRIAL FIBRILLATION y3.Malnaq Delm.
31. Did Tobacco C- - iTo Dean? 32. II Female:
1 . D.eA:i.n Nee,Pee r•. D n.,r ara.wwr: ❑ww.v�to nwant vet a ar:ao.� 0 Nasal 0 Hand. ❑Accident 0 Penang InseRtmm
❑.Yes ❑PraOeNy Li No ®IInNlven -D-eras a.gweeom*.+i-au.oam D Wean v n.etsee The en r.. • ❑&lode 0 Could Na Be Dearttired
3s. Date Of Injury(MaavD•y/Yeer) - 35.Time Of lryry - _ 38.Place Of Vpsy(E G.DecedeirS Hma,Cdnstrucvon Ste:Rmbuant Vdoded Arm) :.37. fury Al NM?, •
OresDNO--
38x. CmY Or Tom 383. FRo:t 6 Nrwer- 3BC. APL No. •red Zip Code
33. season Of limy-State -
" i ' ' S �5ineo .•
39.'Desm3e HOr Vary Octuted - _ 005,5•505 mTn On.efle• ,0a-eue.dn
- _.� - - '
41.Spvwn,.Of Person Can:tyro Cane Of Death: - `�- 'a2. Cert3a(CMOk ONy Oia) .
BRUCE CARLTON BRINK JR ,BY ELECTRONIC SIGNATURE . - - • - - 0 De^Jyu sRhysdan - D ref' : 0 Hun Ofees -
43-Name.Address And Zp Code Of Penm Cendyig Cane Of Deals - N. tirerw Nureer' a5.Dar Ce11eed"
BRUCE CARLTON BRINK JR-;410 NORTH:MAIN STREET,PRINCETON, IN 47670 • 02000610A -'05105/20'15-
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,!6•Add3ma Favra Serviu liorlN _ _ - -c.,` 4 1 . . �.,,.; a .... r
'- � A9'.Fa ReglstnrOMY-.,pea Filed(MdndVDaY/YV).
as.BRUCE w IN H A,NIIA - - „ 1. MAY O6 2015 e.•
BRUCE BRINK JR,2 ELECTRONIC SIGNATURE -''= ,
AMENDMENT 70 CERTIFICATE OF DEATH(ENTRY.OR ORIGINAL) - - I
I' Sc......: . 8 301 cot qD? cot
a� ao., I - . z•
State•Fain 533951'ATiENTION ESTATE The Soc,a(Seaxty n is Deep requested by dw date agetty n order to purse respolsmddy Disclosure is voluntary a C Shia v^6_oe^o Panmy refusal }
-,`�' ORIGINAL•DOCUMENT HAS A MULTICOLORED BACKGROUMD ON SPECLAL W1111E SECURITY PAPER AND THE GREAT SEAS.OE THE STATE OF DIDIANA ON BACK THAT
TURNS FROM ORANGE TO YE__OW WHEN fa 7.1.:ORIGINALD000 MEW:NOS HIDDEN Vf.11D FRONT THATAPPEARS WHEN PHOTq_COPIED✓