Loading...
Death Certificate - Miskell, Mark A_8/10/2016 -..-dr-----2-1,7Hrr ....ill UM-Hfirt; r-----1: INDIANA SI Aitt.;Utl-ti* •.IiiiriEnlii:;91i-itAbTHprij- !!-T ra'• f ...‘ .47;:-'..‘..01:- .'"-$1:-'t;A:A.- SCf :'t * ' '''4....k,"•14-4.41 r<ttLW •••■.LarC411 1"iiitiFICATE160.1tiatiii 1 *-- ' 41- - 1 -7 l• ''' r gL a -........-74t,-sii: NC, -, ,. -, .1. - '4„,.. 445-,. - • 34-41/4. ' "s kc,L _4.7,i,o-ArvIIII4 fr 411f :11, A. :51 ;;.-I . XIII: ,.1-.N` It'i• ,,..Iii-"",A. %,---:-C.:7,SLO.C:alEN0-400011198L1 -.,c :SEOFI;i4o 000000484666 „ri& „zt'atelMei059628:_ii:i 6 1 E.,,,c-seft,,,,,-.Nnt(Fuvw.t:r...,...;:,:f:tr",-.:1,-ris.qw-.i;-,v-::::-I fm,,,;,:iiimpettitk).-31finil;:ifikic.....5-;ifi ?:-.;,:f5-*°11!)-psp. 475F,Tretirk-yrq.„...., @r- c4MAiiKk4.11W;;?..‘telt4r,4,1&r:-.:,,, „J.-44 C.,244.11:-.-:t.itil 1-;,--;ci,„ irC1/4-4.11: " -4-"c5T0tCte,2th 1E-...-`441 kilft/--'1.1;IF;';.W;''..-''11 -441 MARECAMISKELL :_,.. ...".;•:-'*I'l:-."..1/4-•S.." ...-`-". .Ci..----.::4--,...c.„- St■-.■:-..... :::".. c.`...": k;.&"-... -c'.1%....-4.1.ALE:,:;.>....-k07:00.P.M>:".4.1. k,_ •; . t tIO If Deal,°coned in A.Hosocal .4t..,,„;: '44,i ,,,C.:-..,44.i;nr,,:14” tt0e111 Reath Occurred Sorparere0”sr 315anA Hospital?Etcm..4;o ;i is!F.:c.c..;iliry.,,,-:47i p..:,;,..H.r4r,;.-., i4;is „...4 : S1-7[1:-...?: 1:::‘;72:.•'.. ......4.: <4.1 ,:-?.. 74,4).54,31.-„-- ".'::4:1".7.,..1!:".4<-,:c',.":,.•((zi 1:11:14141.4.5Y.:(;11€1 De6C45;ces HoTe...'; :CI Nur ..Florna&241-term Care 0 Yes'ID No r 0 UnktioWil 0 99999i99 0 Ea979999.D99911th155'.4wialca 0 Dead or":'13-6;rer>soani'l'. 4 -9:;4. '' ; '''4' l''t.SN'S;'‘‘‘C--"1.4s::\' ''''' '''''' r 11t•Facity Name:Al/Not Instorzcn.Give Street and Numter)4. „ :7 I f. /(C. -1. 1 It C'i ; 3 I- ; : . ! ! . . - 7i 72 SOUTH180 COUNTYROAD EAST - . ...,..•:. 511 PRINCETONFI ig:47670-, '' '- . ,... .,:?If... - :Th-Y-":...:,.i •-; GIBSON ,i„; 15.Sttnonng Space's Name t: . , - . t.. , • ... - ;' /fr. .,15a;Of VW9Give Maiden Last Name :::::,• „, :„.18.,..0ecedents,Usual OccupcOon { : i17..CKrid0fBusryactustry:,4-;.".2 '■ .t7:, .f '..:.:. :.-' . - : -- -....-:- .c-.. ...-- .....-siff.:-.;-c-• :,.! ..," -,„ :;- -;..t.; ;. .. s - . , :ERR'ANN MISKELL • - , ; -. ,I : ', REAVISI 'I :', C , "._, .c.:: : . HOUSEKEEPING : ', HEALTHCARE i . .....- ' - . '' ' ' • • 1 INISIANA:.:'' . .'''''' -- ...'' ' GIBSON - ""--... '-••:•??:. 'c'l...... PRINCETON :';%,...;, .:Mc.. ::•?:-.., , '''' „ -"..„/-- L.:r-%"-tit<c>"..I• ■;:.. , .; , . -• ; ?- .; 7 •.. ' "_ r . ". .. ., • -... %.i'. I - ..‘'•'' -,: "-.,. . 2> - i : • - ; I : - :': 2 SOUTH16000UNTYROAD EAST ',.; :' 4?'.7.6 70.•...- -:'0:.".-.•.?..,,:---Y""e.,.s 2. . HIGH.sdHob:GRADUATEOR GED "4-/:0 t--'t-"r"1 Nt o 5'''.,1''',.•'•'"::.:r'," , ,,:--.... i.c..kt."'..f..- cs .,.,,.. ,.."' a,_•2-!"- , F,-?"•;-1.I.:jr;-%_, :' ,,(C-.. .?..., ); COMPLETED •'''.."''.:C.-••••••• .-. -t' NOT HISOKNIC --",---1,-...:" ‹ '. .-.; whice i.,,,,...,. ...,-..?:;:'„ ...-...??,.,-., . . - - .....„......,...........,„ „....a....„.....„2,....,i,...,., 4 23a Nimes Maiden Last Name : 22 Faders ame(FM Rifle,Last), ,, • - / - 7-. 't -,: : 1:.:S.IS:,....,.*%-:.' t 1 ,. . i..... • , CHARLES MISKELL ' 7 : '-.. .-, . ? ; : HELEN MISKELL-. .; : .; ..,t : ; ' MONTGOMERY? 24a Relaticoshp l'o Decedent i.,,, 24b:Malmo Address.(Street AnciNurnter.Qty:State.2tp Code) % i : t ,..:/ , i.'7 •C......IERRIANN MISKELL" ' : ' - . VVIFE•'''(.. i"c•'-'•:. .."•;%::: 72 SOUTH-180 60U5NTIROAD•EAST, PRINCETON, IN 47670',::!7 ./;: ".'":•:' - 25a Method Of Otsposiscn , t : 25b.Race 01 DESPCSit-011(Name Of Cemetery,CrencropsOmer Place) 244 Lcr.a?cn-Coy,To.4en,,Ar41 State ' .i. ' -''' "IC ' - - „ . , . 078inal.0 ace;naton 0Oonsoun 0 Entombment 0 Rendre'J FrocSoce ' , . , , • , .:.4. El ot,44(SPec4): ..., , ST JOSEPH CEMETERY"?. . - .... .:' PRINCETON,1N . ' ,, , ...., . C 28.Was Cauner Contacts° ' • 27. Name And Gomplete Address Of Fte:fal FSCitly- ,,/"",.... ..."--'k.: ,;,.1.- ,,,,,,,.. , "".. • 27ei Funera/Horne ': 0 :• ti ca reeer Y 2NO / c ; COLVIN FUNERAL HOME INC,,425 N MAIN ST 'PRINCETON, IN 47670 L . FH83006671 ' ..c.'I •-; / 1 1, 27b. Signets°Of lolana antral Service Licensee: ; 4 4 z• , 4.., e ".-.:- ' 1.4 i - ....T;44t1, „ 4 . .4 t.: 5.. .4. „. 274.'License Number(Or Licensee): c , ' MARK'R.MALTER,?'BY ELECTRONId SIGNATURE. / j .' ..: ',.. ?.',,.-?.,.? ----- .• %:. •;.. ?..d FD01013010- • , • . . .....' "" -.:if . , - . ..... :. • . ; :Appr9:3irrate:j!.- 28.Pan 1:Enter The Chain 01 Events -Diseases,Injsmes,Or Complications;;Iii9r Oiric9;Ciliaatt99139111'1.Do Not Ealirs>.t -• ': . . .. - - t, kitervat;Onset s‘ ... • Suoh As Cardiac Arrest,Respiratcry Arrest,Or Venticislas FibrULation 9,/lhcur StrawAnd The Etiology.Do'Not Abbreiriate'EMer,Only Onetalie On ' 36 Do-ati*:rf.... '? A Lint Add AddOnal Lines If Necessary. - ' i - -7'.. i •.• k,... . C,■ Immediate Ciuse(Final Oise-ale Or Condor Resuttirg In Death) . A: RESPIRATORY FAILURE 4 : 4 .. ?". !r • • , 4 HOUR$ '• ' 45 1 °R.,:tiari,,...11.mlrnr`we°P .," ; t12 , .1= , . • ' . Sociarathey List cono.00ns, It my.L000ko;j To The Cane Lis- too On, 13 ' MUSCULAR WEAKNESS. ..- „... ..t....t.i;%cu( -t, „ ;6 1:405.gg<tS4-:-.... .:Lik- Line A:Enter 312e Underlying Close(Disease Or liltiry That birktatecf .". ", -/..-'-',2'.'rff?-5:-44. •r-C?“:...-6".. i:'"- - , ic.-;'. -91' . '. ..1 .The Events 12...... . . st, , , . • ' CI CHRONIC INFLAMMATORYOEMYELINATING POCYNEUROPATHY , i , . 18 MONT14S,"..5-4 rc• . ' ' " - / I ; ; - -, ir 1r c. , - I,/, : Pall.Enter OtnerSSIRS:antCondocc4S,onmbut4na to Cern But Not Resoltrog In The upderh"Cause Grin In Partl. tt 21.3 Was Anpsop.sy performed? . , 0 Yes' Wrio 2/; ,‘r.,,,:;.......71; ■-C. :::. . .. . . . ' • :'' ' ' ' _ AUG;1..6 ?me. : , . - ,.... .,---:„. ...,,c .,.. i- c--: 3?),,,kTty:Prineirvia...?!Toc?..opienrcay."?!p..??-:o::&rsUilliOtz; •.: 31.Did Tobacco UseColt:doe To Death, , ,. - - - 0.415;surnmem PsaYeas 0-F47.4uTs.6.Doa, 0 I...p:o=?..1..14:.'4.var.c P;set 0..z.1•• 0 Natural 0 rioacide 0 Aoddent 0 P fr4/4109 401,1.94P,K;urg 43 orrio,1,41,84444 Des."zoo 0 u44.44440044-4water,4444 to44, 4i-t- - 0&Jade 0 c.:ood not Be CUOsernincf .."-",..„„1. •t.4.-.otzt`? 3 • .34 Oats 01 Injury( 15 Time C InSoy ,t. ,' - , ..;..; 38 Raab 0114)jyry(EVDececienry Home,Cc9stution Site.Restaurant wooried Area)Z.,:- 37. Irttif At Yr? 'to : • ki - GIBSON COUNTY AUDITOR - ' -,. -I'- .1-0c.■- • ' --'' --' ' • • :0 vas -.0 No " 1 99 Laraton Of Irtuy-Stew - ; - ' - l'.: . ' 39 Cescnbe Now OWEOccurred . . 40 If-franca-orators tofu'', ty- " 3 ., , v : •.,, ' .v,/ 1 j.:-.1.,.:' -,,,, . .2 -.", „;'; &-`'..X •- :... . ` . , . ••; 41.Signausre;01 Person Cemfying Cause Of Death. • ' ROBERT D.:BOND•'; BY.ELECTRONIC SIGNATURE .'-',:.' ).Ji.%„)'-`,,..!--......'"..."...-C. :;;;.--':--`11:;„:?-13,-,-.4 ,,E3- cenimerhg(physician ., )0 cerone, , 0 Win;este,, _.,4 .. ... ‘.1 43. name.Address nd bp Code Of Perim Certifying Cause Of Death: • , , , . , , . - ' ' &- , • ' "4 • '-•: -; •4 ; ,' ROBERT,D. BOND 685 VAIL STREET, PRINCETON,IN 47670 ":s' :-'••• ..'" ?"---." .L" ...:' --2...s' ; - ' 01030202A - t . 12/211z0i5 - ,:' 48. warr.c.f.Locameeofr. ., ' -„. , , -:;-,- •,-,-;',•-„,e-7.;:..?"?, -.;?-±,:.;sze.1;:;„as,vs-;;;>#7 i..,,.:. '..‘ 4,-.:-F-Re!eF9NY :gel F961sii!°?"gaY^::ie-",--,;-1-zc .3e.1.:::,-.[:;,-; ct -13-ilUtEl3kr-Ni-KjilFk:VIAIELECTRONIC SIGNATURE1., 't...'-%.,4.1 iii.::::•.r4i ,1 :,%..i..1%----/..1 1.r.:::231 t 1.gr.;r:i. 1. ::: :: :::..: . .', •t-2DEC/21 2015 •, 'sTi:c ;-; -3 ;;;;./.:::::-..SS.".rAMENDMENT:TOCER11FICATEOF,E1EAlti(ENTRYOR ORIGkNAL)...■2;';:,..c" z. ',".C,-2:,. .,,,,-.!.-.0_‘.„-W...W,,":"..r.;ECC4±49, .-1,4;'..i -4H c....-.4-,i.:;i2,-,t4. , ..5.-....;• ;;-...-t...c,,' ;1.1i '"-1.:i1;=-1:,'!rKC"!".1 .......;c":1 tirt!'":".!::+4,=Th..:,,t4711R4lizt. In.::: -15111,.;-;:::.z 'C.f..-'''''Y Frtr,.::::rgF.7..--C4F.Pit?..-5:457.1-WW p tcE-cccic... , -.s,...-5.,-,-.s, .. .n2,< r4V51::: 44.;.< 4. _;{<,:; 4 :::, t.:-::,„ t<"---,' " ,--staw ,.,...„.„, .,..c-.7t.,.,,..-....c.-....-;,...-......„.;,..„(....„.;..6:. ... ,,,..:.t.... -.5...,::,......:, .:. 41 -.Li, .<" ....f ,,,■.,...... i ..,' ',.. if,..0 ro,,,,j r., - ..i.de , c;,".... ,i,...21:,,,,,,,,,,:::ci.., ;';,,,,r;:-..1,;;;:::;,- ; i w-,1,....;-;.---j': --,1 rj----z!in.-. k ........... r; t.,-- ....vt,;:czi:Es,,,;:-,-,..-Eir, ;:rts?-„::it,,stt--;:fri,n, -.,.-.liz,-.921-A ,-.7i,: -..-,-,tr..;;,:-....rr ...-- i■-:1-ri 1:::;>-;;DiCV.:-C.-..i,,s ..41,."'", , ..':- . ....":"..k..-:'' ....,b,......., eff:0115.33,95,41Atigm04frspki-rzrscciilisajfati$iiparigirjrasted_by,tii.sptalc 89:115Yjnm,i.tims iii...itszfopzgy3 lry."Toy,,....b)rx„,x1re,..:iiiir-...: -. it .. ---WA-A*114d . OilIGINAtDOCUclalt HAS A MULI1COLOREDBraltrUNO ONSEGAI:WHTTE SEGURITYkeEff AND THE GREAT SEAL Ofill STAIE0kINDTANA ON BA.CCT14iT -. •tTURNS -.8 OFtANGE,TO YELLOW WHEN RUBBED:ORIGINACDOCUMENT c.a.§HIDDEN • I ON FRONT THAT APPEARStiVHEN PHOTO COPIED, iZZ,,•.2 Itx>,>.:/..,