Death Certificate - Siekman, Gary W_5/19/2016 a ANA STATE DE RTMENT OE�HEALTN/. II s I .L/JI � a 1 tCERTfEIC,��Tf OE DEATFI/� ` \� . �..,l��`›\ % tR / �_:' a s', e `EDR No,000 0000 0496265..,E<, stag neOlDeDea1bt•880 _ .i IV ! , ..J ,1 v7 i-�tvam--1 ,f . �1J, .--.a., qr.- -31✓"'°I3`2ei i �/J{tiaill�'% ilro f rl'I \. `�- �. \.- \�, \ :• >!?.MALE3S: 508:35 AM ?: �02L17/2016 j Q GARY>W,SIEKMAN.. . y_\ n• t%•1011 Death()severed in AA�HosonaY�j\)'�?2�<I i I rrryiil 10a:Ill DerJtOccuned$an ere Othel,ThanA MOSgIa�illl��li��: I I,I!'" �fiTz;Hi refi 1 4.„....9..' ��aj\�h.\ 1�\��.✓`. \�f \ LITFici ce FaaUyC 13 0eceom[i HOirei` ®wrsing Horne ong-tenn ae Faan .),. ,,Ir.'� 4 :Oves ®NOrOlUn nvxn Olnpabent'O Emergency Dewnme IDuSa enl.Ooeadon Amvaf -..4"er(sor-II., >''�"^� '� r�."' 1 .- �1r•�Y k'., i .il✓i....t ❑✓r 'v'/1111Lc e:Ii C-bb)llsv/.UJ[%U_W.nrr P,:I < '{i�111 L!.. , . %.. tt f;Faciry Name;(If Nat LSUym:GNe Street and Number) 'Y:' 'cl ... $?it �1 r'C .e\ -.`!tG<\+F r\ \V " �C, t HAMILTON:POINTE;HEAliTHrAND'REHAB r. --.•? :•?.�r`'� „r.-.: � TS•,>T.._ >- ._ i\�:;n�\ .r,. .�i..,.. . . ▪ l2 Cityocrov t Sae•ArdZp Code / I tr/-it vj r: Off { . 1! Lt3 CauntyOfDead,r �_ t I IV . i4MaitelStSt3 AtTme Ol Oeac'f I H ,r. 'iii i w r a /rut G t -`\, ' ' `:Y .: A \'' �� \ ` - � \,•. \ y'\�-. ` r- ®'Mamea❑Married.But Seoaraed ❑Onorced; .1 a .�� NEWBURGH,'IN,_47630/t11� ' .ii/5.�111 i .�il:.� - i"...-.I-.-,^<I�! i WARRICK%' iii%_, ../'.1 „1'r. ..; %1=1.:ma ,,,O Nmv ni"ded''O U"t'tv`r' ,' 15•Suni.Mg Spouses Name a \ c e.;;t(; -141 s•-- \ ItSa (11Vide)Oive Malden last Name T4 . -Mti 16ADeceaent's Usual OmNOOn J I-I KrtWOf eusbess4ndustryZ.' -v f rtr/:f �Y/f�ir 1' X 1�1i ! - �.'i�pp'' trZ�./Ci -ice i I\ ' COMMERCIAL MILLING. ; c GWEN SIEKMANtilfr'i1IF%,' : .:<111i— :: ./-'` lie.--. CORN 1,'!(/.,4Lil� - I LABORER ./%..I ■ L:bOMPANY•'?ril W/; : , 18 Residence s State \\ �,\� '\N - tba Count^,. y✓ .,,o.p NI6c City Or Town\: ✓ \,�,x 'y:y� ,. .A� �' ./- I / 1 R��m. ip OT, Y 1 / S /.i.-: lr • !yiy tI i ^/ t IBSON i. ✓ r�s�t( 1/I: / 1 I ., INDIANA '.-LL�ti''Vi.�C�sLI: � �e GIBBON��'.: ` ' .?W BUCKSKIN ,:': ' . _.ia/<r 4!S:-:z ,,•C . , : �<r" .:\.' 6c$treat Andw bar. yv -9,..'R - \ y' r y• i' 3/ 16d AO-Rd?' Mania eode ) 1M inside ClyUrurs7 3 i/ `I%/..all a{r�t� �lii ! ,� r 1' �i j / ' �I fjP II �I , i.O Yes ®No 8437 EAST 900.SOUTH \�`y \ ;:. `\j, \ �C� x.` • .•�;='�z 47647 09 Decedents Educeadnr 1111.✓/(in y% 11 20 Decedent Of Hispanic Drip 'i r IR /uI 2f Decedents Ram 11+w J >• Ix -":II / - �I -I v t--„;;.,;.;:,. ' " HIGH SCHOOL'GRADUATE'OR GED 'a �l(e/�aGtl!�y;\�'Lllt, =1-,,....‘4'41-.Tr-J.” i11�, .,i Y4l \ ,i !r-.Z. ,1 t11 >. COMPLETED:/ fl$"i eit .Lin NORHISPANIC1S,?4,1, C'iriw, . .:�i While r ::�. ..- :'> xli.>,, /ei. >;,. a. 22'Father's Name(First.Mode.Last) I .'i! ri > j/y..LV2 I :23.Mothers Na a(Fbst.Mddle Last) I - ' t -23a.Mothes Maiden Last Name . C \�`dY \y . ` � �/4`�� \{ wt''<`:. ' �S -..atlh‹ Y ;e. \ s �, - y x'°.`i4VccNc- c. • 6 IVAN WENDELL SIEKMAN a t�Y�r�� - Yi' !R i IRENE IDA SIEKMANr .i;St (' „�tr � 1 k 24'Informants Nano i - Sc.,' a Retabonwa To Decedent," R-Q.:: 240.Wing Add ress:(Sdeet Md Number City,Stax;Lp C I F CS II `' .:± '‘'...Z::7•>")".... \,t?.-i , , . ..I.':- WIFE re.:::: --▪ i� a!Y . 6 37::EAST OO SOUTH,BUCKSKIIN~,'-II 76{ � _n:,:�,.. ,..� ~ �., GWEN{SIEKMA -.-;;^,•Ek<.- ■�k>'1/4-1.: a ``\'4&4\�C"_'>'•C'riC\'YkS.72`.irEa Ci3;rtiCndoupa`vuoniK ti ,f-...Sir_C.._ct`•\; :�\Yk'\`�VY.-..\•'•:.-! C-:_vE . ;71 25a Method Of OlsW Vtion 75o.Place Of Os Name Of Cemetery;Cremat r Disposition( +tY any,Other Place '2X Lamaon Ci Tam AM Stabs r ire , crt i<i Fi 1` t'( MAY 1' 2016 ❑4,ci ®Cremation O Don• ,;,O E brtidne t "1 �5Tt-- ,) s/L.II�tsji •'I�in '!J 1 i.'•_- � • e Y ❑Rengwl an$IY. �, ` \ ac. � M`� �R\4, �\,7'�j� \�\ >... 4 '\� �/�/� \\ • '0 ome(spearyt �llsy II EVANSVILLE'CREMATO��R�Y��It�_i,�/ N�Ilia ,It EVANSVILLE;IN N III,(Lils�nhi �▪ iC/`lu /> ! r. " - a 26'Was Coroner ContaGeC> '',....-:..m. 27 Na a And Cairye a Address Of Funeral Fatty , V U.� � \I t, �y�-\`\y`� Home Llmnse Number.•"--> LAMB,BASHAM MEMORIAL HAP,ELyrINC�'226•EWASHINGTON STREET?O r- - ' I pK • • .O, 0Nr/E.:t. .L. , IN 47660 :. c-'ILI'i//.elU ,Mll16iall!!r .r JI_% i1IE✓.21UIE!r'-'„ -;Wf ',,.UI.,-.e,UitioRII-OR .- s .27b::Sgnawre Of Indiana Funeral Service Licensee:Y;\�>r• � \ 1,,..-- .lr, r\. I iil 1✓ II :: - FD0101e Number(OfLi n �llli !nil f? : ✓ JERRY L.Er�E�'BASHAM:,-BY,ELECTRONIC:StI1GNATURE;TIY/i d 11;S 2i .. . L ;d�+..;.I K\.':sj \. \w, `� a ix: \t' ' .;\v,us?2 .athl((Sea lnstruct`ons An`E`SnWls)V t `-\r ;y .,'�V✓e'.'ppprowm ate '"' 7t x;28.PartI Enter-The Chan tHF ants1,EDiSeases iyune'Or ComplimUOns�Thal Duectly Caused The Death DO NOIEnix,Tennmal Events;.hi`N%/'ll\ s..-1 •11,9:;:t!.11.' .- \ °Interval.Onset-, Such Ai Cardiac Arresl.Respiratory Arrest OrVenrncular F'ondation Without Showing The Ebdogy Do Not Abbreviate'Enter OnlyOne Cause On /� .f I.: l I CSI To Death A lane<Add Addi.bal lines If.t ecessary `ttj�v�. i5/ J,er:\ -\x \ i�C'�1/ \t V C `_`f 1„— i`Cw!` • : t trnmedale Cause(Final Disease Or Conti omR SWdn'g N DeaVt1.II` RI.++BILATERAL PARIETAL CEREBRAL VASCULAR ACCIDENT 3 t r r tt /i x 2MONiHS ✓ ',at11 i[[�,,��A<�� Ili r "*Ikk 4G.as M y <�11 { � i P tt Sequentially List Land bar If Any. ...>LeagiN TO Tne Cause Listed On'' f Bf "✓s��,x �it ✓ \ �• c�c''i r Nit Jr.. ? ▪ , _LineA Enter The Undedytng Cause(DiSease Or iyury That Initiated ��.1',li�\t�11 r ZLF/t`Ilr:fl r.M i2 - S: ' „9„▪.,.. -2▪ • •f The Events Restating H Death)Last' � \ . C\\�St�t,S \..\.P\`..x T.,� ta. .\.<1.z• \ t • .' \ '' .>' ` t.3' Mb16 +'wpm - p��1,1 ,r �.' i fl i . 1k/';� �.1�.,...we st'>4:t±M`C` ll 43.CaG..2 \Ir t 1�%�'1.i;ti/ ; - r--; _ .t Dom • .Part .. 1;:$...... �De .Y_\ O Part IL Enter Other$ tCOndtions ConbiWtry to Death But Not Resulting InTn Unde..c Cause Ghat In Patti Y 29,Was M: -.r-..ertorii? t `,' V...-s. 3/ Il✓4 6//J ll.rjj _ /`�i .,js• i-S. JIE'%�. �� A .i r / n �. i '.O Yes (G_®No ri IC!• i/ Z.\K.i�:,t.:\41.4?/.. 1 c t, k�.`\4L:��i.K� c”.rc-\�C\\_�'wtaeMaos�F Gu,gur`aa\ao"T°Ccfnpi�iy`G>�0=0eirr o Yes.D NS•, k• - 31.Did TdbaP UZ Corakwb To Death?S: 132 IYFemate.%/,xl t t I :,1111 /-%If?'e J 1!ibi t i' a1 33 Mavu!°t Dead t . . I e i n r ' • e_:Yes.0.—� atly 0 No un n✓`,'tC Rfi.-.t i "�' II f . �.if we!:h.ej . ,1D"•x+'wRC-Z,..v..▪❑KAS, ,W O" '+.v.KU .ew.-,,r on. o..s; I ®Naval,Ols.wee DACCFbnt OPeeiigInesd9axn/ ❑V�s ..Pmoatly DNo ®-o<., u� >' Cp\orLh\"lM C 0n!i \`VF0 .-`U.. V.l ."•,C\\ .r'C. trees•Not. e\vn .. 4-h.. Gat ,• . Yr\v >w�..✓ ❑r4».ew ea .aw.s p... e....a.�O r».v.: i+v.+ a i ❑sukke 0 Court Na Be e Determined!, 'na`.:-'A� 34 Date Of Iryury(Mon%JOaytYear) �'','�/ 5 Time Of lnlury/ 51f� 11 36 Place Of It*:ry(E.G.:Decedents Horne-Construction Ste Resw rant.Wooded Areal▪ 37,In(ury Al WOk Ii (':. v` . ey L``: / \.`�,yA�^/��i,,,�� \` ct ,r... �/ L' ''+11� f c-1/4,:,.2 / 4<.�I '�• v()Yes.7C O No M .ny7 n-„,� .:\v'7ifec��i%i,'i.:Y' _ ;� a ;C lr '::? _ _4,s1""..'. 38.Locator Of njury Stae+ fi;Y/` ! .W O!,Tsmn/ilj' i; "j: i c 36b.i Street 6wmber I 41AptNc td 8d Zipcode \ \ �� 7 S _ ��`' -• 4 - _' : rR11./Jlrnr ?/_ /iT✓I aft,k ilt i1(.Y - _ r.%