Death Certificate - Young, Glenn A_6/10/2016 I , .: » ; INDIANA S� I ti,9 �
c ? CERTIFICATEOF DEATHr ` � \
<��: 1.. Local No`000089 ' `' k 'EDR No?000000510062 1 State No 021000 )-?\ /5• L.Melon Name 81feral-),
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1.Decedent's Lead Name(Firs;MAMM oasis r / ';‘,5,1,1:7111e.1°,11,1,12.11111.01111111011);.,'
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3LENN ALLEN YOUNG - > ''' "-'' ` `^ MALE, ` 01.45 AM 05/032016
. 74- ' Maw .✓,- Days ' Hours; Mora '. : .1.•''': 03/07/1942 FRANCISCO:IN
9Ev.titUSAmW ftmY1 ,0 UDead10avradnAW.pdst r - ,10a If OOaJtOmrsd$wtwMre OasTMAHOSpanl,� 3 ;
_ ❑HOrpO FI[ity ®Daoie�f>}- TS -'p.ttsuV Hana�Vblm Cat FaoBY
p Yes 0 No 0 tlrtioeell 10ItSteaa4 0 Ea+rymtt Denman OLSt p Ceed on Armal .p poor(Swots' .
it Fealty Name(if Not ataxia,.Gus Sant old Number,
4713 EAST CARITHERS ROAD a Couuyal3.an u:Mama Saaaurm.p Dan,
12.CM Cr Taal Son,And 230 Code . , -
10 Ian M Mad,as Saoae+a 0 Divorced •
.• GIBSON 0YAowed p Nap Maned.,p Darren •
PRINCETON, IN,.am7670 15a al Ma)Give Maiden last Name 16, Decades,usual Otapeom ' , 17;KM CI BJ.e:emgnar .
15.SuvMtp Spane'>Name -
MARILYN YOUNG CLEM MANAGEMENT BANKING
13'Resgerca-San.-. I8s Casty -tea.COY Or TOrm .
GIBSON PRINCETON
INDIANA - ,60.Apt NO. lee. Ze Code' M.WideCay Men
,BC saga AM Number : - - • ❑Yn 0 M
4713 EAST CARITHERS ROAD 47670
19.Decedent 20. Decedent Of Hispanic Odga 21.O. tsRae , •
SOME COLLEGE CREDIT, BUT-NOT A NOT HISPANIC White .
DEGREE - zx Motets Maiden UM Nero.
22.Gahm Nana(First,Mil e.tae): - ffi.Y[Llr•Nana(Pest MCd..las0.
WAYNE YOUNG LUCY YOUNG PARR • -
2A.Warman Name '24a RSICOUtIP To Decedent . , 240.Main;Address(Seer And Nutter.Cory.State.to Cods) ' .... ,•
MARILYN YOUNG WIFE - 4713 EAST CARITHERS ROAD, PRINCETON, IN 47670- - '
n:Rae p Disootian . .
25a leeaod Of Depos>at 250.Race Of Oispoa0on(Nana Of Cemetery.Cr anlory.Other Rau):`25c.Location-Cory,Tam.And Sate
0 Bind 0 Cre na l.0 Donato p Entomme t '•:0 Removal Fran Sts .
0 Other(may): ' FAIRVIEW CHURCH CEMETERY PRINCETON, IN
ffi.N'e Corar CPresaaO'Y 21. Nara AN CarroFlae AOdrW Of Fad Feoay /, ♦ 27a Fad Ho=License Nantes
0 Yes el No COLVIN FUNERAL HOME INC,425 NMAIN ST., PRINCETON, IN 47670 - FH63005671 • .
27a.Swam Of Indan Fad Senn Lic ns• : - 27c.Lion*Number(Of UUnses): .•RICHARD DEAN HICKROD., BY ELECTRONIC SIGNATURE . . �'�F001012153-
. - , Cause Ot Deeth (Sea IrttructOna And EaaTm)Iee).' -APpmlvM,e .
n.Pan I.Enter The Clan OI Everts -Diseases.OFries,Or Ca naa/atiors-That Deeay Caned The Death Do Not Erar Tecwfl Evertor Interval: pees"`
Such As Cardiac Mast Rester tory Attest Or VeraioMr FiCnitatiai Wend Shorty The Etiology.Do Not AOtravlate:Enter Only One Cane On To Death ..
A Line. Add Additional Lion If Nece•say. • .
immediate Cause(Feat Disease Or Condition Resting in Death) A GLIOBLASTOMA MULTIFORME-BRAIN 9 MONTHS
.n.al*MAcay..aaon
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sewn.*Let Condition. a Any.Leeding To The Cause Lived On B. re.-web w•��o>
Lisa A Enter The Uadelyel8 Cave(Disease Or etjtly That Initiated .
The Events Resultingn Death)Last C. paaloeaAce.s. co-
. .
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Pal II.Etch Oats 9t Not Rana?In The ltnneltr9 Care Given In Pet I 29.Was An Autopsy Pertamedl 0Yes 0 No -
31.Were Asapsy Fstlaig Avesta To Congee TM Cause a Data 0 Yes p No.
31.Ltd Tobacco Use Cammaa TO Deem? 32.UFarala, 33 Miter Of Deedt
p us"r.a_w.,vv a• 7 we.•.e•va•e QM!,am ' 0 Naaaal 0 Nomads 0 Acodsrt 0 Psalm 0Nestys'ion
❑Yes ❑Pro0e0N 0 N ❑Urdnoem 0 ra^av�a es'.wa T•, o„a 1 • ee.ta,...�. ❑Suads❑Cold Na Be Nominee ed .
3a Dale d Irnaey(MandiDayNn4 - 35.Time CI Irtay - • • G.Dewdatt HOMO,Cantratat Ste,Rottman,Wooded Area) 37. LwY At tam? •
•--- Dyes,-. ONo
3.Luaaat 01IryaY-Saa 38a dta Twn - JUN ` . �2U1%a Nar Sec AR NO. 3a .$Cods
a. If Traoeatntl beery.S teofy pone e.dn '
39. Casaba How O- QmnW //�L -- fisincO.a' p'°n'
41.Swan,.Of Paton Cec yrc Casa Of Deadc - 42.Cates(Chat Del one
THOMAS MICHAEL WAITS, BY ELECTRONIC SIU EOUNTY•AUDITOR - . •0 C*57I Pt,yalos, 0 GtlPe 0 ua Oner
43. Name.Address And Zip Code Of Pram Ce dyep Cane Of Deedt _ W.Lioane NIn10a a5.Dee CereO .
THOMAS MICHAEL WAITS ,3699 EPWORTHROAD, NEWBURGH, IN 47630-' - 01050532A 05/03/2016
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aS.Adsx,el Ford Sawa Proeidr' __. . ...
ore. Siptmlre r:awl Meal 011wr: - . - .- a9 Fa Reafetrar0TdY Dore Fad(MafbO5yfes).
BRUCEBRINK JR'VIA ELECTRONIC SIGNATURE .I. .` .' . i I ' _ ".MAY..04 2016
,AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) - . - - +1
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