Death Certificate - Barnett, Billie J_1/9/2017 ', # ;ia_ , •- ;a.- .-'fin., 1r�-i�•n:. `- �`-•'... 't;"4 CERTIFICATE OF DEATH G. iii'- at e?, C i ;r =..
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, er � LDCEI No 000176` �� $EDR NNN 0000053-1750 dx x ,..stateNo 0.43509 . a.W E;
;;'IIDeUa'dJent's�Legal Name:resL yNOOP:Lest)/:.tll /`I PlIrt 1 -�`y-�,',� r�yv�.M'�,m/�Na f�i' trO rY 1 I�(Sra. ��]�� yj it?}a3'III j°Ir f0�i Fig ),� I
r paiY.<y4�f/ F/ ,/''V1s�fr VIM; ASS{:."L„, � �I /.JI I 11 I�lI Cl/ .��I
• BILLIE?JEANIBARNETT � �f�,T+K\\ rTHORNE-_ �C`�E��ec FEMALE<\\07`02 ace(C I&.dS�,.09/10/2016''i
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1�7�7i+�.. Mawy;t ? Om\ �a.l tke �.�`� •ir!+�a»"� - ` 05/25/1939: MT.CARMEL IL—`. lrv� ri
9 EVernU"Armed Faces] I ;AO if Dear Oconee In AMaspaNr l i / `�,. i V2� I IOa�11 Dea'A OCameD SaneMtera DC:ar TIVnA HOS.a.V / ,{!221 %Ill re-/-3; ,� 'I- /Irll
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❑Yes 1®No ❑Uri,rrgAn ❑hqu•er¢❑Emu9acy DePanntern Or!7a?mt ❑ Oster r .f T � l ?
f 1O9 SO TH MAIN STREET", .arMNU^/ • ,1.. 11,..:`•\.-." • ", ` . ` _:;;7%;.,-1."
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109 SOUTH MAIN:STREET / -
1 12 Cry IXTOS.n Stab'And Zp COde v - 13 Cowry IXDeaN / > 1a.M�taljSenu Mane IXDeaT "> jf
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HAZLETONlIN,47640 vi- -
l15 Sw�mrrp Spouu s Nm�`�, `eY.?. N 15a La▪rt Name Bela¢Fvsl Mama9e, � l r C , 18 Daedenrs Usual Ocagawq-. 17•Kue Of @isv<ssMEUStryt/ 1•
RONALD'M BARNETT/ti Il -..--1 ' I COUNTY ASSESSOR. GOVERNMENT ri 1
le.-Reside a Stag°\ lP ��yyii lea. Carta& y/, 16b,"City Or Tam -'' a
< NIP,A I'._ YG .f' a` `1C�. GIBSON HAZLETON ;'': /• ,' } ,
ec.-5deet Ar Number �yy/�.F 16d.Apt No tee Zq Code- 16f Bend¢Ctytrttfl.
f LF %•.1 f .^ Ali! :•,r / / - ' ®'Yes.❑No•
109.SOUTH MAN'STREETV't.g,'F : - 47640,' - ";,.
(19 Decedents Eduraton.%1R7t% j-i1vI it 20 Decedaa Of HtsparuCOnyn - i 21,DtecedePrssace Ir I�// r < --',115:-:}
SOME;COLLEGE'CREDIT BUT NOTA� • • E� J. //\fIY:.%<, � / - {r '•
" DEGREE F. 2•• ti It T:. NOT HISPANIC y 3 White -_` ti's - -t. '1 ;
22.Paents Name(Zit Middle.Last) •t FIFO/ - 23 Pare tts Mane(F L MWOM?spy; 23a.Parents Lest Name Beare Fae[Mamag: E`
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I ROGER WILLIAM THORNE�It�
' , GARNETTELAINE THORNE- s . WATSON I� 2I
L. 241ntamaLL's Name f�� , 24a Rtlatiortsttip TO Decedent ! 24D-MaEq Address (SDeet Md NtmOer Cry,State Zp COde)'r /
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, RONALD BARNET- t s - t . : HUSBAND 109 SOUTHMAIN STREET HAZLETON IN 47640 / >.
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24 Me:,d et empoei•m`;'" -_ ^C 250:Place IX Dispmiibn(Name Of Cem etery Creme yc/Ozer Race) ' 25c.lncafm Cay•Tam And state .. \u�-y:,I
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❑'.RemwalF am Staff \. / F�3
❑oM'erl.t"Ie:Lth li ' HAZLETON COMMUNITY CEMETERY•. HAZLETON IN ITfIi fT
26-Was Coroner contact:0o. 27 Name And Comple'a Address Of Funeral Faafty 1,,,/' 1\ \ 27e. Ft.nerd Home License Numbe 1I,
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®Yes ❑No
/ ,w tc 1 r a COLVIN 9UNER.4L HOMEIN^ 425 N MAIN ST PRINCETON,IN 47670. -: ': ,. FH83005571 /i t I' .I I.
J 27u. ST;maare Of Iodate Ftncal Service Licensee N> \7Sr \\∎"',• T • F. 27c License Number(Of licensee) ---.C-,•••••• 5�: `
, RICHARD.DEANtHICKROD-,"BY ELECTRONIC SIGNATURE . . -/L ' FD01012153: . •It< /'Tin •F
._•r\ • 1\ - (t. s DAMM Of Death (Sea ImNSCUms And Examples)s ,y-tea H F lIA.` ate U r /
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� 5 Su.A L ardac to Arrest,Respiratory sp Evens Due asV rgnculas,Or Canpbwtvs Tha' .g The Causal The of Att se Noe Enter Oitt O Events r�..may e
A m As dd Add Arrest uc Arrest,Or Vercs}rular Fibrrilavi W1lftare Srtrnvet9 The Etbbgy.Do Na Abtren. a Enter.. One Cause On Y ll;'= n'rr/ I
ALne. AEC ACCtvul Lam hNecessary. ` - / l';',
"le Feat ,,
tt�eda'e Cause(Fatal Disease. Conti-,min Resil'stgNDeath) A VENTRICULAR FIBRILLATION t a
/ ' - la JAN ; 9 2017 I
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Sequential&List Conditions If My Leading To The Cause Listed On B ATRIAL FIBRILLATION s- mow\ 4�� _ //\ -•'
lire A Enter The Unieryutp Cause(Disease Or!Niel:Nat Initiated / "
.The Events . •.-",p.-Death)last -L i Pc .,. /••1 'P '� t< p :- GIBSON:COUNTYAUDITOR 1
• Par•II Enter ONerksincantC ConTbr_ t Death BW Not Resulting In The UMMyvq CauseGiven in PanI• 29.Was MAtt?ps"Pelatned? ......❑Yes ®No 2• /?,•`,Z;',11%, c—^I•',
;✓r • TR7,2,4G ._,t/-..sf/ .l.i . ( 33.Were Mangey Ending A aiabte To Coreiete The Cause Ol Death? - '1 G
1 j. CHRONIC OBSTRUCTIVE aeTo DeARYDISEASE 2^-..• - �- /: - _ . . _ ❑Yes ❑No a (c
,r 31 m TItacm Use CMIW.e To Dean, 32.If Fertile z /f 33-- Marna IX Death. - \.- +1/ tit.\v .e•..it i, 1: ✓'3Lt.lam! iES'' . ❑ _'n:-,. vc., ..% ❑n.a.e - aw ❑ r:.K t:alt i. -.,aomae.e Naval O((aide '❑Acadia,❑Fen&rro(rva>mamrt.- i
\ ❑Yeses❑Prob..-®NO ❑l)nbnm\ �•e 'e
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34 Data Of Injury(Mm3VDayttear) - 35 Trme IX Injury 36 Place Of tiny(E.G.Pecedeccs Home Cmstnnaon S' Restateant Vboaed Area):-_ 37 tryuy At_NMK! /f I i
�. G �.: - . ;/ t t�F.i // L t- ., � ❑Yes ... ❑No
3e•LocatonOf Injury-Stab y"* 1 36a. Cry Or Tam ,• 360 Street6NaeWt '3ec AR.No. : 36d Z9Cale. �/
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1 L 39•Describe H Ireury occurred / / . ❑ lo..m..e p deo7"
1'2 41 Sigeace•Of Penal CaRaya g Cause of Dean 4 ( a a 42 Cer4Sa(Cnxk l}tly One) •
i'? JAMES.MICHAEL NEAHRING;BY:ELECTRONIC SIGNATURE >„� EI circa rw PMstean.; ❑commit ❑He*h0ecer ." <
• 43 Nar e.Adeess And Lo Code Of Persot Catdysig Cause Of Dealt , 44 license Nanber 45 Dab Ceitsed -a
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/ JAMES MICHAEL`NEAHRING' 4007 GATEWAY BOULEVARD`NEWBURGH IN 47630 /. 01042748A 09/17/2016
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31 4B-'Sigtauia d Lttel HI.W:9`cer -a �. % / r, ti' v/-rte / a9 For RRegIstraryOrdy Date Fried (MantVDey�ea) 4 t 7 -' t`■
I,I BRUCE BRINK'JR VIA ELECTRONIC SIGNATUREJII _d1 :i iE./ I L.? II •iP i :'rdt �� I -"SEP.19 201611 ..":51%;% r'ti ID111
\ . AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)•C .,CS" :\ 1(' ^H. /C,:i t'.-QS f
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