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L�t ,� ' RSZ i I LCERT,IFICATE OF DEATH' 4 < ��,+ s �• �r .�
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r Local'No \ 000004155791 030609 \ /
€ I t:Desedelt Legal Name'FvsEMid.".eltaslT If lrltl7 /1 1' I e\]a M em igf lemaeJ�:,r, tri:yY Z ea r'IS % T GOfOeat t\ DaieOWeal�/� Day 'i)1
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Jyt PATRICIA JO'HEDGES� �'�\ E v1�\w: � DAWSON�"����r�\"\�C FEMALE .\�04 30 AM__�. �06I2512015\ �\�
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9 Ever ui U S Pmied Faces? I 10.It Oeath OCarted In A Hosp W ). I r10a II Death Owned Somewhere Omer Than A HospW� ,: if,. 1 ...t. f% r'.". 1 3
IT( ` ~`^+'I •'4°� \ ,- F1\v-i\.+1 ,'.CC e,. - ! Y r 0 HOSPICi Faasy- O Deadn' Hare 0 Ntasing HamH(nng-ten•Care FadiY...!.:',.. ..;::;:':.%1 r N.
}yss ❑,Yes'.0 No 0 Unknevm 0 Inpa em O Emergency Depenment Oita' nt 0 Dead m Arrival C�
.. 11::Faa ty Name''gf Not Istaltak Give Sweet and Number).'
ST:-MARY'S!MEDICAL CENTER OF.EVANSVILLE .
INC " S _ - :- - .
:112.City Or TOwn,Saa{And Zip Code _ _ 13 CanyOlDeath 1 > 14. Mahal Status At Time Of Dean:: i i '
\ \ i X11. - ' O MamMO warned &a Separa ed ❑Divorced .�
' EVANSVILLE IN,47750 , =,_ VANDERBURGH ;_(% - :Y 01Mdo.ed .,0 NererM ee->0 Unknown _'
tl,• 15.,SrngSpanes Name + 15a. (IlWte)GtveMaidenlast Name. 16-DecedenrsUsual Occlpe:rn 1). Kind Ot&,sinespInd swy;r. :f
n TERRYE'HEDGES ' , s r : £ LEGAL SECRETARY_ LEGAL SYSTEM
18,Residence SWe lea.'Cdunty / 18e:,Cy0r Tawn\
INDIANA.. r GIBSON PRINCETON - '',. - r\ 7 >� +'
1&. Sweet Ad Numberb - \ ' y ,r 18d Apt No, tee. 2 p Cdde 151 lnsie C y limtsi s
948 SOUTH DOGWOOD LAN E _r. s • ) >. . • ,. fi.:; < s= ; . 47670 0 ya l,7 r o
19.'Decedentseanoc.n / s` 20 DecsantINHtipaic Ongs - 21 Decedenre Rrxr
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` ASSOCIATE'DEGREE(AA;AS) NOT HISPANIC ' �. ., White . .. �4'
22 F Whet 3 Name(First Midge Last) 23 MCUe(s Name(First.Middle;Last) 23a Moue( Maiden t Name-
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EARL WILSON DAWSON i - . ' VIRGINIA�L DAWSON ; ; MYRICK
-. 24 In,'mrorKs Name.. x. - 24a.Rsaoonstep To Decadent 24b Ma6rg Adaess(S tree:AM Ntseber.Qty.State.Zip Code) '
a - TERRY'E HEDGES .\' : HUSBAND • ? 948 SOUTH-DOGWOOD LANE,.PRINCETON.IN 47670 -
4.' 25 PIece Of G:WSdai'I "tom'`, , '\.•
. 75a.Mewed Of Dlspositio ' 25b.Place Of Disposition (Name Of Cemetery.Crematory;Other Place) 25c.Loco on qty,Tam.AM State .
s ®'teal 0 Cremation 0 Donation 0 Entombment . ' t ' I I :Yr' r." - '-' • ; , ' ' .
_ ❑Bemdval Fran Save - :: / ".. ,.�� '�._
▪ 0 Omer(sootily): .../ ' COLUMBIA WHITE CHURCH PRINCETON,.IN -.
o • 26.Was Corona Contacts? e 'N 27. Name And Complete Address Of Funeral Facity-" r • :. `\ > i ' 27e,Funeral Hone License Number
0 Yes El No , COLVIN FUNERAL'HOME INC,425 N MAIN ST:: PRINCETON, IN 47670 : . FH8300567.1: tt •
'- :27o.Spratre Of Indiana Funeral Seance licensee:. . - 's• ; •27c•license Number(Of Licensee): � F
RICHARD DEAN HICKROD,;BY:ELECTRONIC SIGNATURE . • ''-' .f \'• '' FD01012153 a ,,
\ „ 7 _t ., - ,,.n Cause Ol Death (See lnstmchons And Exampled -.. Appromnate
x 28 Pan L'Enter The Chan Of Events.Diseases Injuries,Or Compticatiorts That Dlrecay Caused Tine Death Do Not Enter.Tennmal Events Interval, Onset
Such As Cardiac Airest.Respiratory Arrest Or V.1100 1:Fibrillation Wthout Showwg The Etiology Do Not Abbreviate Enter Only One Cause On To Death r . ,
A Line Add Addthal Lines If Necessary. -- \ ) yy��
Y ; Mmedae Cause(Final Disease Or Condbon Resulting In Death). A CARDIOMYOPATHY tees _ ,
v.Sequentaly List Cond,tcns,"If Any.Leading To The Cause Listed On ' ,• FEB 1 5 ZO ( \ \ •
Line A. Enter The Underyng Cause(Disease Or Injury That Initiated ' "}r' ▪ dv.aR cs..aene ac ,
A�; The Events Resulting In Death)Last C _' r>' !
-a.mta ce'..ea'I Ot -. M/iii
q' Pan III.ErrorOther$bu'tpantCod ionsConlnbutnatoDea:h&aNmResUtngInTheUnderlyingCaseGivinlnPanl' 129 Was An AutopsyPeQtB5ON'GO_ hen o1No �•
30 Were AMOpsy FVAVg Avaaable TO Compk:a The Cause IN Deani; _.yes(JNo ~
�t.y7 _CEREBRAL VASCULAR"ACCiDEN1 t. I' r - 0
f , 31'-Did Tobacco Use Conmbue TO Death2 v( 32. If Female. . 4 1 _ S 7 i re ;• ; : '33 Manner Of Dean: l 4, , _
0 Yes 0 Probably 1'I•No 0 Unknown '.tD°.�"nwin lint vin 0 n.ww4 aer 0 `haven e4 e.w4 van cm.aari 0 Nacwa10 Homicide 0 Accident 0 cend+g lmes5gatm
C - . : _ ' , , i 35a iaeina.ein.w.a o-.. c U z sy( G D• e -TMant - e' n Stickle OCaW Not Berea) rvred t 7 " -
11!EE77�.. Date Of Injury(Monmeawyeao 3o Time Of Injury 'p38 Place 01 lnpry(E G Oecedenrs Home,CmswuCtun Ste.Resattn.Wooded Area) 37 friary At Work?,
�� - `\ -r .,r ❑Yes_ „❑No
38•Lo a o Ol lnj ry S •e 38a. Gy Tam 8b Sweet 6 Nu be 38 Ap No 8d p Cade /
]9.'Deloibe Mow Injury O-pns ' Treentei a:gn Irsay eory '
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' 41. Signature, IN Person Certdfng Cause Of Deadti : ' - - a 42 Cer ler'(Cheek Only One)
`�t ; JAMES MICHAEL NEAHRING 7-BY ELECTRONIC SIGNATURE . , . , El Certifying Physician . ❑Coroner : 0 Henn Otttcer:i ,
43:Name,Address And Zip Code O1Person CeWyig Cause Of Death. : ti i 44 License NUnber 45. Date CM Ss
' :JAMES MICHAEL NEAHRING , 4007;GATEWAY BOULEVARD;NEWBURGH, IN?47630 -. 01042748A , :-06/2812015'
)Si' 48,AOdbonal FtmerS SeN�FOn,der. '+ -•"3' %i w; 47. 'AFae. : 4.',1%. t
+,t} 482STature-Loc Hea'mORa >' , 'F \�'"; ,.., 49 F Regstrar Only' Data Fred(MmtsDaytee/) �+
ROBERT KENNETH SPEAR VIA ELECTRONIC SIGNATURE t,,: s-:-.< < - . _JUN 29 2015 . ..?..t.711..,..1 >
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