Death Certificate - Hunt, Yvonne Marie_7/5/2016 In� �.,`r INDIANA STATE DEP• -TMENT OF HEALTH- r
CERTIFICATEAOF DEATH
Focal No 001081 `-EDR No 0000005:148391 state No'026298 - 1. �`
,I Derraents Legann.r.et A+mle.tasty;.: :;- •IL MadeaNare(If femae -
: sews.... .3.:Tune Oeam- .. a. Daeaath(hlcnur,3arnea)
in U.S.Aimed Forces? 1011 Death Ocared In A Hmpta • 10a it Death Owned Somewhere Oter Than A Hospital p -
Hospice Fealty p Deceoem's Home 0 Nursing Haneldngtam Care Fealty
p Yes 0 No p Unknown 0.Iryatem 0 Emergency Departitem Ojtpaiem 0 Dead on Amval 0 0,,a(Speedy)
It Faddy Name(II Not butYeon Give Street and Number)
DEACONESS HOSPITAL INC •
12.fay Or Tovm,Sate.And Zito Code _ _ 13. Corny Of Death 14. Manta Status At Time Of Death
0 Manned 0 Maned,But Separated p Divorced
EVANSVILLE, IN 47747 - VANDERBURGH; El weaed p Never Married p untnwn
15. Srniwg Spouse's Name 15a. (If Wtae)Gree Maiden Last Name 15. Decedent's Usual Ocaiarco 17. Kind Of BusinessAndusty
MICHAEL HUNT CLERK RETAIL
18. Residence lea Canty 183. GayOrTwm
INDIANA GIBBON PRINCETON
184-Szeet Ant Number 18d. Apt No. 13e.Zip Code 185. aside City tests?
529 NORTH SEMINARY STREET 47670 0 Yes ❑No
II. Decedents Educeson 20. Decedent Of Hispanic ergo 21. Decedents Race
9TH- 12TH GRADE; NO DIPLOMA NOT HISPANIC White
22.Faehefa Name(First Weds.Last) . 23.Mother's Name(First.Made,Last) 233.Mothers Maiden Lax Name
ROBERT PETERS MARIE PETERS ! JOHNSON
24.I.nbrmaas Name 24a.Relaionstip To Decedent 24b.Ma
ding Address(Street And N&nber,City,Stare,Zap Code)
MICHAEL HUNT ' HUSBAND 529 NORTH SEMINARY STREET, PRINCETON, IN 47670
25a.Method Of 25.Place Of Disposition •
2 Burial 0 f Ot®Domson❑Eruan6rrcm 256.Place Of Dispostoon(Name Of Cemetery.Crematory,Omer Race) 25c.Locaean-City.Town.And State
p Removal From S re •
CI Owner(Speedy): . ANATOMICAL EDUCATION PROGRAM INDIANAPOLIS,IN
25.Was Caner Contacted? 27.Name And Compete Address 0l Fawn Fealty 27a. Faecal Haste License Number
❑Yes 0 No KELLER MORTUARY SERVICE, LLC, 801 N. MAIN ST., LAPEL, IN 46051-0431 FH11200031
27b. Sonatas Of Indiana Fawn Service Licensee: 27c. License Number(01 Licensee):
Cause 01 Death (See Instructions And Examples) :
2B Pan I.Enter The chain Of Events -Diseases, Atervat On
Iryuries,Or Complications-Thai Directly Caused The Death.Do Not Ether Terzniral Events To rce ate
Such As Cardiac Arrest,Respradry Arrest Or verb-biter Pito-Ration W„ha71 encodig The Etiology.Do Not Abbreviate,Ella Only One Cause On To Death
A Lire. Add Additional Lines If Necessary.
Izmttedate Cause(Final Disease Or Catdaion Resulting In Death) A RESPIRATORY FAILURE DAYS
a are to As acesrgeaon
WEEKS TO
Sequematy List Conditions, B Arty,Leading To The Cause Listed On B. LIVER AND PERITONEAL METASTASES OF UNKNOWN PRIMARY MONTHS '
line A. Enter The Underlying Cause(Disease Or Injury That Initiated p"0jO"'"�°•
The Events Resulting In Death)Last C.
De a or Aa A Cweew.e old
Pad B.Enter Oma iWtKam Candban Cont numb to Death But Not Rezrh In The U at ve Pat I llll 29. as An Autopsy Performed?
0 Yes 0 No
30 CHRONIC OBSTRUCTIVE PULMONARY DISEASE.HYPERTENSION �� re Autopsy Fidug Available To Compete The Cause Of Death?
❑Yes ❑No
31. De Teta=Use Cotten To Death? 32 It Feriae: i 33.Mama Of Death
0 titt Reamvaw=stew. p Naval,n.eaoea p raw.aesee acaaoena_.r ®Natural 0 Hariode 0 Accident 0 P
mbatfy ED No p Un'vnown b Pending Irnezngaaon
0 Yes 0 P
pwn.ae�Aeaneawe C dra Tenro.>be pc'JU u&' 'eg ---`mast` ❑Suicide 0 Cake Na Be Determined
34. Date Of Injury(MmttDay/Yean 35. Tame Or Ir try 36. Place CM lrqtry(E.G..Decedent's Home,Ccoamaton Ste.Restaurant Wowed Area) 37.injury At Wort?
38.Lora Of Intxy-Sae 38a p Yes ❑No
-Gu'r Or 3& Ant NO. 38d j6 Code
GIBSON COUNTY AUDITOR
39.Desate How hairy OceorM : -- - 40.It Transporaean 4aay.5��''.wmeay.
.. pa»„dew.., peawwea.LUl eiarwe. pmrrzn-i
41.Sgeeoe;Of Person Certifying Cane Of Death 42. CectSer(check One ire)
DOUGLAS JAYE HATLER-, BY ELECTRONIC SIGNATURE. 0 Gee-eying Pi an O Coroner p Peen(3Yer B
43. Name,Addess And Zip Code Of Person Candying Ceu--Of Dean 44. License NAanber 45_Date Genet
DOUGLAS JAYE HATLER ,4498 FIRST.AVENUE, EVANSVLLE, IN 47710 01039937A 06/06/2016
46.Aaaoma Furera Savke Noises`. 47. •Akar
40. Signaure of Local Hea'mOfBcer. . - '' 49, For Registrar Only -Dam Filed (Man3vDay/Yea): -
ROBERT KENNETH.SPEAR,iVIA ELECTRONIC SIGNATURE "'JUN.06 2016- - .
. t T AMENDMEN L TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) ,
la '1OoiboaQWQaa8Y
i Sae Yam.53395.,ATTENTTO)T ESTATE:The Social Seasity e ie being requested bct this store agencyi n order to aasue respoistIty. D:scbsure is vohmay and gyre welt besro penny fo refusal -
WAFiLV1IdG ...,u ' .FROM ORANGE OYLLSWHEN PURRECD-O IIGINNAL DOCUMENT HAS HIDDEN-VOID WHEN PHOTO COPIED, SON BACKTruh