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Death Certificate - Julian, Alma Marie_5/23/2016 IM .----). -1' '' - 7-7- rr'n.sicalmjarea, Arrt•,,,'), l, l'''',,, ''',,:. 1 t 5,11,IDIANA STATE FITMENT OF HEALTH ;-.5,5. -1V: • f. c- -: 1 : if -5-* '', 'CERTIFICATE OF DEATH C c I46. ,:i i 5.5' 5 ;' ' $ . i : ; -; • -.5 ,i F. .? ;; ! • • 5 -.5 i .. c, i ; 5 ; ; j -5 • ; i ; .-.7...'.-Ladal No'.000027; - s- 1/4.‘ --E 1)9:No:000000502725.--- ..: :z.statiNo 013991 _ ,1:.Dece-Xaras Legal trante(Fes))Middle,Ias)'''' .,,.)'-•-,,,,, ‘ ?e:..Mairtert Name(II Tarria!e)'-:.- .:CP; a 9.°)l:', ''''' r l al'rime O(C/eat/1 tr,,,, 4. Etale,PlPeattl7.1F!ifiDaYliRiti ALMA MKRIE.IUCIAN ;i : C -:; ; ; 1; 5 -5••: ) 30NES! .55-; "; .." 5 5r :'55 :'55 FEMALE, '09:515 PM,. I:-:5 03/22/2016 4 in U.S.Armed Farces?, JO.ITReath Occurreo In A Hospital: ' „ a - . 10a. If Death Occurred Somewhere Other Than A Hospital P. : '.: ._,:• ,,, ; P,.„ ,,, 0 Hospice Fay 0 Decoders Home 0 ilCrevg Hcrnertlrolig-temttaie gaCtity, -)-1.-Z7‘. , . .. . b Yea 0 No 0 Unanewn 0 Inpatient 0 Emergency OesaSsnel:nouusaseet EI Dead on Arrival 0 (SpeciFy) ; . ; - . .,.. • . t .. t ," 11. Facety Nate(II Not Insatutaa Cave Street and Mincer)" ) ; : . , - , " " 940 LAKE DR 5 - ; : ,, : . t , ' ' • " - • ; 12..Qty Or Town,State,And Zip code t. ,: .- - 13.County CI Death t . 14. Marital Status-At lime Oi Death ' , „ . . •.„ • . . - ) . . , -. . [rammed 0 Mauled,But Sepaialed a Ovomed. ...... -- •- - . 't."':- 0 vA3e;ved•. 0 Neaer Marted")'qp Uditaiorn, PETERSBURG;IN 47567 -"5 . : ''t :5'' -••"55 •• :5:5 -'• .5 ;-•• : PIKE •' : • - -5. 15.Sorutang Spaces Narne'‘ ,-, , ' - '‘ I5a. (if VOle)Give maiden Lost Name 16.iDececlent's Usual Occupaben - • , - RETIRED SCHOOL . - . . TEACHER PUBLIC EDUCATION ' : : ' 5 : .; ' I . . , • ; - . . ts.-nesidesce.State . 18b. City Or Toon INDIANA GIBSON '.... ,• -. .." ,.,• . OAKLAND CITY - . .. .. ; ); '••• - led Apt No. . - lee. Zip Code .•' ' :,184!!--NeqY Urnits?'„ 315W OAKST , , i . ' ' . , - . ' : 0'.Yes i hp • : , ". 47660". .- '; t ID •19.Decedent's Education . - " - , - 20. Decedent 0.11-kspaaic Ongtn „ 21. Decedent s Race - . - . MASTERS DEGREEIMA;MS;-MENG, ' :5 --- :,... 5 ---' 55••••• --.5 ,.., -- ,. MED,MSW5MBA) 5 : '' .5‘>: -5.5: - NOT HISPANIC : 5,,-5 -." :5 :- WI:ife .:5:::: •: ; : r•-• -• ' t... -5 5; :• --- ? 55 2-5 . 23 Mestere Name(F's%Mk:MM.las) - t 23a Mother's Maiden Last Name . , SHIRLEY JONES .• : i ; : ; '' t; :7 - .t. i :,l :.• 1. CLARA JONES .) : - • : i ; ..• MULLEN 24.Irde.onant's Name -) ) •‘ ' ' 24s,Relationship To Decedent ' 240.Mail®Address(Street And Nurnoer,Orb Slate:lie Cede) . --- .• WILLIAM ELMER-JULIAN:Hi 1- • ;5: :: ' SON " -, .: .5: ' . ' 1222 REDBROOK OOURT, INDIANAPOLIS 'IN 46229.•;:' 25a."rood Of Dapcsieton )r . l 25b.Place Of Disposition(Name Of Cemetery.Crematory,Otthr!lace) 35c.Lccaaen-Gay.TOW).And State ' : l : i ) 0 thane!AD Cremation 0)6ortahoh b tNombrrent • ", i ; . t . .: ; '• - ,,,t , ' '. ; , , : t ', : i ,- .. . ' . o otharctspecifir,:.( ::::., --,,,-1.,-. MONTGOMERY CEMETERY - 21.VMS Coronertcraacted? ' • 27, Naine And CorrMete Address Of Funera/FaciiN . ' OAKLAND CITY IN - 27a:Funeral Herne license Numbest, , , - • LAMB BASHAM MEMORIAL OHAPEL, INC:; 226 E. WASHINGTON STREET;OAKLAND CITY, 5" 7- ‘5•". ::: :: :: : 5: :' t. : 0 Yes 2 No t ' '', :IN 275.Segnatsire Of kdana Funeqaj Set-are Licensee: f , , , . ' - - -. ' ' -.IN 47660; : I : 1 ! : :: t• : :;. FH83005312 5 : ) 27c. License Nutter(Of licensee): - • ) ; ; '': - JERRY LEEBASHAM ,BY ELECTRONICSIGNATURE.: : : . • ' ,; - : •. -- .• ; FD01016589 : 5: .: -. •••••-5 ;; :: i•••••'- •5 .---catse.ot Death (See Instructions And Examples) '', ,, Aoprricrirnae , .,-.., . 28.Part 1.:Emer The ohs;r:Of Event; pDiaethses.lirlitt:el.Or COmoticatlons That DirelEtt)/Caused The Death.Do Not'ENS./Terminal Events ,, . Suds As Cerdac Arrest.Respiratory Ai rest.Or Viiiencular Fibrilla tion Without Shoeing The Etiology.Do Na Abbreviate.Enter On'N One Cause On . '- ' A Line. Add lcdcitinal Lines if Necessary. To DeaJi . • hamediate cauSe(Final Disease Ot COnditiontReSulting In Death) ' A RESPIRATORY FAILURE 1„ ) , , . . , . . .. -% . : DAYS : •--seikientiati List COriditions.-If Any.Leading To The Cause Listed On .•- B WNOESTIVE HEART FAILURE MONTHS Line A. Enter The Uccle:lying Cease(Disease Or InitnY That inn iated .. . ). - i c,,e(o..e.cre.ve-coOii. ',. The Events Resulting In Death)La's, :'• -. -- : " ' ' C 'ATRIAL FIBRILLATION . - ' l-- t - ' :) ).). , Pd d ; , ,- • ; YEARS 0..PI A.•Ca.,...".00 .., . . . . Pad d.Enter Oder .critrota Conditions Cornier:4,c to Death Bra Net Resulting In time undenyipg Ca.use ChM In Pan I. 29. Vies An AutopsyleiformerN ,:• :Ei xe..s: : a.No)z/a : , z.: l•.,..,, ,t Wsra .. FSsdng- . 31. Did Ta.roc Use Cantribute To Death? 't ;32. II Female: - -.. 33 Manner Of Dean:, i : - ,- -. ''. • ot..yeii 0 Probably 0 No b Lards n i 0 4i!...7""7"-°;','"ar 0°;+-t'i.rt°'°'''' c?"'"'"4`1".. 3:".”"a wr41.2 et"°' '''' 0 I;llawral 0 FId'icide b Accide"1 0 Penning iriT:1;a1)R" 0 Stkide 0 Coda Na Be oete;msried • .• i ;i 34. Date 01 injury(r/tint:Day/Vex) )) '' ' IS..Time Of Injury 36. Place 01 Injury(E.G.Decedents Home,CalsMictien Site Restaurant.Mooed Area) ' 37. llura.4.1Worri. .. „•- -,,...... • . .. '..-0 Yes'«...0 NO' . . 38. 1-«aecil 91 MlarY-State. ' ) • lla.Or!Or Town' ; P 355. Street 5Manber • 38c API NO 38d ZlpCtde . - . . , , , • , . , ) t. : ), ) : ,• - ; - .., ,.. , „ • .- , . ,. , . .. • ,1 - ... • . ; .ID Otne0-ara at OPtiserce• M1*W+.0 0241,(Each) 41 Sagrias.ra Of Person Ceatt9rç Cause CX Death \ ' ...... ''....„„• -„ . . ... . . . . . . HOLLY LEE HEICHELBECH, BY-ELECTRONIC ` ;: :55 55 ' ; .5 - . 0 42 Cenjlper(Check ONy One) .Ceniaing Physician - ; aCraioner •••0 HaatirCtices ; 43.Rame,odaress And ha Cede Of person Centlyav cause Of Death: t , , . . t ., 44. License Nurses t 45. Date Cenaled HOLLYLEE‘HEICHELBECH , P.O. BOX:266,‘ 1020 W.:MORTON STREET,OAKLAND air( :IN : i • • , : 020032415A ':: :". '--- 5 03/24/20161-'5'5 .5 „46:Addiannal Funeral See-ace Edovjden 'a P•P-••' ,„. ' ,_. 41 Ai-as 43.,Signature el Local HealtdOlyero) - •••• ) : ') ; ) ;t. ; • ' _ :' 49.tor RegIstrar,Omy -,pate Red(MclunDayrrear): -r... ., : i ,: •, ', HONESTO K FENOLt,VIA ELECTRONIC SiGNATLIRE t= 5: " '. ; Is. 4 ; ::i : ::" 5: 5 5; '; '. ;MAR 24 2016 ; AMENDI9ENT,TO CERT1FICATE OF DEATH(ENTRY OR ORIGINAL) '', :: '.• ; . -, e .• i ). '. ) ; ,,' ,z ; j , ,-,•1 , „„) .: P,I. ---'" ; k: - ' "-- ''''‘ ,: „ :, I ..,\ a' ''' : i L -_"'" - a Cr' ''). ;"'`'- •-%""'''', .,"''`sti„,0" ''''' :."..t. ,1/4'''''"' .-"' ''':. i''''''s '' .' „... .,:: 7 % •,' ,: , , i .• Z ' .....• .., •; ..-• e. ‘`• k. ••;) 3 S , '' !S .• '1/4' -. r ... 't t .., ; ' ' '. ' '?, t t. :i .... '1 t.‘ Z■ . . .... -- %; .7.-.- 1 1 ',I ' • : ; f. i ;,. ; I r; Yi .: I 2:' I. ..).31 1 %.' •, ' ' , 1 ...' ; ‘ ; t 1 ; ). ... .1 • i , E: f .-. i -- tafiforrn 53?95 ..ATTENTION ESTATE:Theito,dial Security I is being requested by thiistatC agency iliorder to pursue responsibeiN. Ddostirric is'voiuntaiyAnd.ththp,erill be no knotty for 151631 WARNING• ottpuAtooc MENT HAS rc MULTICOLORED SPECIAL WHITE SECURITY PApEDANDT,NE GREAT SEAL Of THE STATE-OPINE:10,NA DNI3A9,11TRAT'''„..--- ''''-. ii, ,, saw...TuFINS FROm OrIANG :z YELLOW wiiE11RUBNED-ORIGINAL DOCUMENT-HAS HIDDEN VQLON_FRONT-THAT.APPEARS Wlifiv iNinTO enctrn,-- .... .. o.. ,•