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Death Certificate- Harris, Edmond
CERTIFICATE OF DEATH ai,r---2„.„,„;;;c.co, -,En72,- -e),..,&9;,.„---_,!..,--ci- i - _.:si-r6.---: -.71,:rThN ----, llIMIlitrli!IINDIANAISTATEDE13? -TMENT:OPH A --r f ,4!I e..-1 I c'Alli "...;.1.I1r. 4,.%.•-issuiir."-----:5•-: - ikr`Q4•Ir`" ' .‘svo-iii-i-Or ft'alba-FE-1 ' " "' • -- '- ".* ,......... ..c7S:zz , itt.,...w.. ..-- 4 .,-.1' 1"c"- ,,,, r„.---i&A,...ct . ".....: 2; •::::.- . . p•-e, • _.-,..' , . .,"" n ?..>;n- A 4%16'4 - : '>•-zi -.a- .: tocaLNO r,:...c,.. `.:-.z.':-...".4:7-:-.. . ..(,... "..t....:.-EDRNoft..:::-...."-ta,e,■:-7 "". -21.1e,c:2;Q:S.S... ,"State No ivi-r.i fouc.);:.....k4K-J S: is-„ Y :,41.(wafts Lawattane;(FiksPhi4d1C.!.aW W r:3;-.7<0.;'.1'57t7:111:r,C;Ne.%ji '11tall*Ir'N'ff,?!:(111,1",)::."IiftMialiiii:-":, iif-,_IT-1....-;i3.2?-1,..7,cr,”,wit tlicc,91,Fro:(m;,:, .- ,;3} ;), - -7•:: S:11kkl.. .t.11`. .:111W-13 :c-i!rf-",ct.114ST:El ... 1",-(?*Milfaltir--4S4,11,*tii?--ftir:, kvi6cZtiiir: ':;:iii",,,k1147;-: 111.,?eq.kil 5.4 EDMOND‘L■ElfkRRIST-.11.;i'-=.,:;C:-.'" -•.:1!',,c-fi.>„:ffi-::::;;7:'1. tz,--,.5. .c.,57:,...7...--z?.;•ti,:::::.4.1-<*-A - tat....:::4•tra.;:":"..k-tt-,/•:::: :".....>MALEP;51.• S'74 ;,,S.C`s...-:1 : .sgs.:12/27/2007::..-zt.if445. 1>,:- ,.■„.'; - ' t „:: >::. .14P.r4; ':. .. ;Dan „ ,,,:. : Howed22"2. .; -MtuRtm-24.-11'r 2:7 T-1•5' 06/.15/1930:-.‘!: -; IN -.- ';...c .:: 3,5 • 9. Ever kt S.&Armed Fromsg 10:111381510ourred In Ac.,Hismdel: -1/4„.., . ,„.% t; ,.; t„.. . .10a RCN")Occurred SorntrOther T1)es A Homes's' : tc t: -t, s" it- „. I;;:"...C;;;L;1"1.$1. 1 A C k,....-,-:-.. ...s--,A,, 94, ..:, ,.}:r.,,,,.:.: ,......, -„,,, ,k,.. : ..,K..-. -..,.s.,...z . 03++:Fatally :0 Decedenri NM* 20 NOir9 NosoaR-soo-tamLears...FotraYe .ifdsd.);`); sTIRIRK‹. 2). Dyes 1:1 NO O.Unknown 0 Imanent 0 Ernergemy Dereirtmthit Cs:Patent:0 Datd ito mita, 0 agecinsti2k,m; c"' , . -44."' „„, . '' .2, .. ' .11: • Ct.' ;"=-• ' it Fatality Name Of NO Insterbon,Give Sweet and Sumter,- ' dd 1 1, ' : 2 ` d, •.. k; C ::: d% : s„ % C ;•-, ". ' %,, T 2: ; -, -,. -:. ..;... :,. . .: .) r. .1;, . I ; ; ;:-- ? , : , : : . ,,,z, : Code" c • " ' ' T • ' ' ' - 1 - .ir Carry Of Death . %4 : % d 14 14/21121 Status At lime 0100811 1 :-- ;•2''''',. 'IV'S, .,4""::,, . 4:Iz:, : •,,,. . ,,,,,,- • r,,:.: -47 ., ,.. 1.4; ;;;441. ...: GIBSON 1.". ..,. ,I41'4(, ;44444._ .13vvidett5I.,. 0 t17,1!..,i!-,17,-p unigst-2:. C IS - - - -s s- -- - N '' ' . T.T '-..? V- 'T '' S • \T.; '‘ 7? \, . ? 2 r.T.; : : . 1 4 ' 4 • i 4 • : '. ti -• .. 4- / --• i '' I as •t& •.•.? - • -s 5 kr,-- • -5-- ray ,',, : .5-- -.;s s : • ; - -- -s--, s •s • c , s , s -.. -, ., , - ;-• :„ .: „ ; , , ;. ; ;.:. • - 0 yes 0 tio! --. Pt- , 5 .••• r , -- ; ,. ' - : • 5 . 't z tz' .-.. " : .:: •.. "? t 5 ..: , z z i ; •' 2--. t ; • • . :•. 1 t z '"...t .•.••' : ' , . , • , • C Fa9,es Nen CEnt Midde L ) S - ; '. . 23 Medn(s Hague(Vest.Midde Lest) 23t Modwi Maiden Last Hague, C ': ' ' k ' z' . ; :H; 1 ; ";kt ;• : '. Z. ' .', '•#-, .. ?": ! 4-, t..1 '5. E- 1 ' 1:'."` 5 ••• z. '• • 5 • • i . . WILLIAM-HARRIS- i . - , . 1 , i, I ;i ; ELIZA: $ 1 '. .' 1 .-_. ' : : :- --. COLE . , - t; 24 Incnars Name s d s •s . 24a Rament5 To Dewar, 4. .245 4,1719 Addres(5treAn quee Cp Sa .by Code) % - , 1 - % .4 X,' „„?,,,,4 R 4 25a Merlod Of DisposOrn -":, ' t, t , i., 250!lane Of Disponton•(Name Of GINTSIe fy.ereptiOrY,aeffiece)• a Lf:Cari-Coy Town.AM Suite;- : 2 , ' ' ''::• •I'" • ij Dili°&onto";CI Oonnann Entcmtin4nt ‘, . :•, - , , • :i d '- :s •, ::,: '. •".•,-• • :: 7 %-.2. t 1 .% : • 4 t --"-•• V s : E I ta„...,Z > ' ..e't• ,' i'... :". . ' ' 7 r:" '' ' -. %? --.r-. ..-...:.. I : •• , '. " • ' • ' :-4 ' 2 al t. .,....-,... i ' u Yes,:t No ; t , t , , • .1 1 • ; % S. :".." S 1 .' •: 5" 1 . "s '; ' $c• -.2. t ' 27b..Ssnatre Of Incline Fuseral Seneca Licensee:• t s ; ; ; ; f : • d c :: ' 2 2 • t. T R • d 2 27c. Una!"Sumer(Of Unemste} 4" . t g w • S.,,,,$• •„ ,..--$ a, : ...' vd Cause Of Death,(See Instructions And Ssantples),• $$ ,,..1 ';‘, „ • s:,4 ' T", ,$' -49,0,-;dniate )„,. ...... - • -28.Oast 12 Enter T1-1 Chain Of Freels -.diseases:biome,Or CompfiCations%That Direcuy Cause.]The Death.Do Not Etter Terminal Events-_ /- - ‘ : ' 'c onset-t, Sad)As Garde Arrest Respiratory Meet Or yrtrtricUtar Fibralatton WilIgzart Sixrwirog The Etiology.Do Not Abbreviate:Etter Ontypere CasseOn'%-.4,„. • . •-•,) -, :To Death 'A Lino„Add Addricral Linits tf Necessary. • 2,-2. 25 ; :„..1 2, S.,.. .:...:-k i fc ..1,.....Z. , . ', t'.. -4 -4i - , .:,-• :.-• i • -, • - ,, ,:: f - ,.• .,.., .. , ..:., •; ..,..,:zt.. .... : •.,, i -- ' iirM11/ •"" • inviediattiCause(Fin'al Diseaie Or Condition Resuting In Death) 2 A. ' S ' S ' , , - t 4 :: 4 $ : .t. s..., , -4 , .z. ,,.,.. 2 , s t c ,., ; -, : : ; -.. s • ; 2 . .-.:$ s' t "c? t ?.?".','"'"*'" •c' : I ' •UNTY'AUDITORY -Sequeitaly Lust Ca,ddn,s If My Leadi,g To The Cane Listed Linek-EnteiTheUndertiingeause(giseaseOriniCryThitInitied "s ; ;7 --,". -;. ...; s v , s s, --..., ; • , , .,,/ , s t Ct.:" • Thii Evertts Resetting ln Death)Lasts: \`s,;', : D.; ' "d: "I --, •-•2 '•• t• d d d''`"k: : C ::: d." ''''s'T 1 : ,S • % ''''' ''-":"- ' rir- . , • :. : ,.. \ ; . .. -: -,...""C".AC°.."^"*"°', ' -• ., /' # 4 - T...); c ‘ t ; i a c. D': . 1 . ; ; t., a .1 :: a , ; , , a :a , . ; c - '1.• nati r; pan II:Enter 11144Sicn=oLC6atkaigt2Va742ma But Not Remiss;unite g cause Siam in Pan I .,..4 !a wee Artmepsy stegnogner ...- -,ch, $ -0-jig- 2 -• 31.Did TObb=0 USBCCIMItt01 To Dent? " : 32.tf Fernalef$ ' tc. 2. ) " " ••• ` 1--%3 2% --. $ ,33/mamer Of Damn. : : r c , C , . 0'1* ii*"." Cr "g i.". D.51 -D . ".4.71•Caf m 47 Ct./.a timth EINatital CI licenkiSS 0;atilt 0 t'el?ti;TC LITC•4611;b0° t C' El Y,5..P r5i3,p,40 1:1 ufria,,, i 0,:-.4...;:;.,•,5.7..;6;,.,5.,&,..4 .:1,-,..0•,;:1,-..A.:-..., is.,.: -,-; : Ersdac,cfc2idd i•cit se det:nrw,sd c : 5- ,-3•• 3 ,e: .34 On Of Injury rito-mrDayff ear);C ,:t„, t" 35 Tr e a Injury ^-, '' • • -cc 38 4.1ulace Of 11-Qay(ES.01)01CICIII1 Noma Conston Site.Restaurant Wooded Ares)T 32.•trru r!"At 15.)532 s........t: •i @, 1' :t S i• s :- . • :% "' 5 4 t- ;'-'-f a. a,' ^'3‘1:2Z/:- 32 •• 5-,i 4 R 1 T. $ . . , :% t t : 1 % $ T j :- .1:- • ', .• = * z" - -74 ;:.-..,. -7: ' -- 1; '''" ‹":- 1-1. ' =: • t • -; :7- . • - :. 7 - -- :,- .j; i ft' - t '• ' S - T : S , 2" • • % : : : : • s t • .:. PR .. ....now Ne0/71•11(JM,'OfeCtO ::C . ' 41 kigit4ge.'°IPergM,..94 FP",9!pea 7r .- : .Z .';:I'.. .,...'-:\:■'\...../;?;:c :''..::".4.1 P../1:til.S2.'V..,?.., . 42' caverAcheak WY 91°)-. : •'. ''• , ', ' ” !" '''''. '''C:' :-..; t ", `-`,... i -Z. R'Z' c' m.':- ` " '1:2-"da$S..2-2••_c.:„•.• ,2,-1" :2' - •D Certifying Pgysician .. 0 Coroner , $0 Health akar Z• ..: a 'r: 43. Nan,Address And Zip Code Of Person Certtying Cause a Death T TT S".•:, : ' - 1 IT S.ts .; $ ,„ ., 441. License Nutter s t 4.5%De•Centfiedt 't...c. s c o‘ ; .• , .r. ! c. vs - 1 . s s , 2 C • . . , , •.), •S.d I: , " '41„2. S3.. .2,..-:-1:i.•12cdC. "•'`. C11 ''T.:21 's. ."'it ....z'''•-:,. .77 fz..:z411. --•4_51/./..•;-..t..:i t, ,,v ..as. „,-•,,,„ „. $•,"„ s1-•,. 4.: %4, tr"--t«, 4-2 ::;,,2%.1••••••! •„.4,c , Ls&sot se oaccal Heath 0'-cer. , a. t•T ; ; .7 . , .,.., ..-.,_".T.::,,r-t:re,it?.y.3, ti...,„... .■ .f.,,„.,,, 49_.F or Registrar Only -Dab A I a 1.(MonV9IflYurr:..y.:;.."..-% ,,,7*-". ,..,;.•:: 0 Ai- FIRUOITeRINK:1. a'-f.SlaNA71.)12E 0' N. :-FiLE --.-3"." (---2-..!:...-(4.";'; U:le-'.;;,-../1,-'11:46-4V-1,..;.lii.!!.?-,--.Till h‘'.2,--..!, 1-.;;;-:_.E1 ::7 . ti r.-=:JAN154 206-8 :.----$11 !...4..111 i'":::."....V'i, " 4 :,,,....,..- - - -- -c...- ,....-.:,.- - ....p.- v„,,, ,,-,-, ,r,-, "'Ss" l'' TT 11:%fs.,..-'-:::":111:1`r::* - T.::•-:-, s.'"--s‘. ;.L--;-4: .3.-;-7":nittr-12Mig-94:4i111:-tellir's I"- ,,,-4 ilfrailliirCIFIEcnbla ODWO 0 0CT.14:.--0 rtiVirlilill,";:"' '4 -.:‘. li'41,,;.".ft.'..t.-::CY ',..----'1' :,_-: $.... I)Z 1 ii.1 CA.:,;.'.),,,,,, :0 'C.C..% .4.N.....'N , ‘SS;Z,Y>,'‘‘‘::::1 ', ..‘‘..‘ '..S‘,.)'''.."- .. •"?..{41)%e.,/,;.,1111?„... .' t „•"'" "" r'''2•"•-vd- 11":".• :1• r'.2 ;:.5:-•" -3•,....1.T.Sfl S-,....„<j, ^ "it.' 0 (1.-:[1;" a"rt:,4;2,,'-;•1`*--,t4r7:4?:Zyr,:t4i11;.....Cr'Aiii .,-,, '..,-,:,,:“"-I-V .:. • „::::t, ...as .,..4. f,,,.....„3„,,, „ _-,, ,..,......... -_- ,a_..__,:ft?-_-.A.,ii:t.lititsx-..._:„,r,dfiNet:int ,:r to xj.,...-- Side Fain 53395 ATTENTiON ESTATEThe Sesiel Sectirey t/is being re‘ested by this state nimbi/Sri order to pursue responsubity, Disclosure is voiurytary anz then,"be nupenatty for("sal ...., t k. WARN t.•N dKORIGINAL DOCUMENT HAS A MULTICOUDRED IMCKGROUt4DONatECIAI:WFM SECURITY PAPSAND(THE GREAT SEAL OF. ESTATE-OFANDIANA ON BACK T , , /2'; .,4,yy N 1 .1 - . , , ••• i:N MOM•• G . . a • a.,E - lip .•ORICII... 51.5 51 a .. .. ID itt_. se D 5 '•kt ft; • " RS Li.- • el• _ARED?"-'5;14;15.55:11.1,-.552;,t -u '."-ya). t-■..-c-;•Ye.:. 7(._:-.1 -NY :5-2-)",rY,„'"2-cli!e_I STATE OF INDIANA r47 - ---a-YA" r •-7-1‘7*---) -- . - - - - -