Death Certificate - Rasche, Charlotte A_2/21/2017 aI "�.l(' `!( IYf ��Iql ! �INDIANAI TAtEF�ER, TMENTOFr}{EAIIH ! r1� I ,,, r'II III ,'(' `T'.•} a 1 r R `�CERTIFICATEOFDEATHz� \ ..• .,
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t"` .Local No 000224`,,S \ < EDR No 000000233744 :Sate.No 056006.
i r 'la.Matleu Name pl temak)rl,T.7rf z Sits -tz 3 Tame pl DeN1•-.. [P`a-<'Date Of DezJt(MOrctwvay- ;N
4-D�afs l-roalN t�.auaeo . I;,/I T.�/vl 7 tS ,(I, ,.:, �lll1y + g Iv tt!II? li ly 1iit,.<-'1 jL'��' (Il Lair �``.ii v
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CHARLOTTEm RASCHE rs - tnd Mon LOONIER ` FEMALE x,\1000AM ((- .r Foeeig2otmy)"Ot ��l
ar Thant M4aap?al.: - i l ;IIG _
`v^ct�.,x4`s '.1 \'k3ti`a " a"` S- Y OtlospaFa O::DeceeerRSHO1ry. ®NarvlQHOmaM1a,-Ir Care Faalty\ t .ti•4i /t;
9ies ®No•0Un4., Wn ❑wis+eN 0 Emersanty*arin?Naxa5+en101ha]onMWO ❑'ot,),VEs-' •",/• ,
3 i1'F'cagy Name,of Not L`tbM1 Give Sweet and NUmM)t :. i< + • \ :.
a GOOD SAMARITAN HOME AND REHABILITATION CENTER -
t2 Citya Tw..p,E aAnd La Code / 13.Casty Of Derh { - 14 Marital Stave At Time Of De.e- '.
(OAKLAND CITY' IN 47660 +^ : GIBBON Ne°°`Naned
15:.Suvivup cp,a."s Name 15a.Last Nara Betae First Marriage IS.•oeud trs UsualOma t :17 Kie IXBUSressMtlu2y
;fie. 1 war `? \
r i ' . " ). e\ k r/ ..
MUSIC INSTRUCTOR EDUCATION: , r.
19 R zidare SITS 18a�COUnty yS' 1 tld. City Or TOwo •c _ Z-
INDIANA ° GIBSON - OAKLAND CITY= -
1 tea Apt Ne. 'Be Zip Coda' 181 ImMe City Lends?
18c Street Ar,dN nter, ` > -c
®Yes O No
122 DALE STREET a ? ' - r: ? -07660: ' + -
:19.-Decedents Edura:an ? 20.Decedent Of Hispanic On9u1 ^21:Decedents Rau• x - -
MASTER'S;DEGREE(MA MS MENG - • ir -„� / :< �' c
;! NOT:HISPANIC . "O�' White 2'
2 P 'MSW MBA( 23.Parents Nana Fist Middle la 235 Parents 1531 Name Be'Om FestMarage. I
2Z:Parents Name(Fart.;Mittel!.Last) - "", ( aU
WILLIAM VIRGILCOOMER _ LULA B COOMER' - : ITOOLEY -
2`InbrmarasName \ ' .245 RelatimsNp To Deacem Zap.Ma8ng Actress (Sweet And His ter City,Sma Zry Code)
LULA'E KNOLL'.„ - .• - .: DAUGHTER , • , P.:Oi BOX<20,HUNTINGBURG, IN'47542.r p J_
25a;Meded Of Disposnon 25b Rau Of M g:c a t:o n(Name Of Cemetery Crematory,Other Place) 25c.Locaten City.Town Are State ; -
® t❑D,eaton❑Daeeen O Emanone a FEB 212017,
ORemovs Fran SITS' - ``• `'. .'
❑.Othnr(Speay), ,!' / . MT.TABOR CEMETERY e OATSVILLE, IN ' c ` '- ' -I:
28.Was Caner COrt Ged? 2].Name And Complex Addre,SOIFU,aaIFaaity ,/' -- 'Y, \ P. :i-`_ 'K / .. ti' ?]a;F mIH 'r�Nmber.
CORN COLVIN FUNERAL HOME INC 323 N-MAIN ST PO BOX 2/8, OAKLAND CITY;I
❑Yes'®NO '. 47660-0278 - - - - % ` 1 -;GIRSfNCFH (TOR
27e.•Sgnaase Of(nand Frreral Service Licensee..>., / - 27c:,License Number(Of Lrensee) i -
RICARD.D HICKROD,'BY ELECTRONIC SIGNATURE / :. ' J r: FD010121533' -' '' , . -/ I
f q .- .-. \ _. .,, Cause a Death (See lnsirucUmYAnd Examples) s `Appoxsnate t V
`,.- Inta[vat Onset -a
2B.Part 1 ar er cheat.R,sp E+enis -it;Or s dnaAar, i Cat,on tar That ng he Caused The Death Do Not Enter Only One Stith As Cardiac AiresL RespvN c ss ry Or Veivnalar FiWalatim VJ,0lplst Stvwv,g The Etiobgy;DO Not Abhr;cte.Erae�ONy One Cause On ', To Death :e
;Aline-egd Addfiinal Lees H Necessary <rt - c / t
Nimedd a Cause(Fatal OSease Or Caiditon ResWvtg In Death) ' A CEREBROVASCULARACCIDENT " 3 MONTHS ' - '
• t.
OweP ra:..YOda / 3i
uerta List Ccoditbu-If Ana Lead' To The Cause Listed On, B. ATHEROSCLEROSIS WITH CAROTIDOBSTRUCTION- F ~\ 1YEAR •c '�' v
..Late 7y Y.Leading ow la Lew a ) /•
..- TT-AEI/ells e Ev Enter The Underyelg)Luse(Disease Or 841st'Ttal ttitated' _
c'T Rewtug m Death)Last■ - . - .- .- ..
. .i.,MbIP f�oM- •
. :. - x F
7 Pat al.Enbr O t h e r - C r M Crnritsl' mDe lButNOt Resatng In The Underlying Cause G i v e n Part l 29;Was An AUOpsy Pertamed] '` Owes ®NO / , •
•
/ PIDE ` \ / '` 4 30.t%lreMropsy Fna,..... iade To CanpC.e The Casa a Death? ;0Yes.O No. . �
DYSLIPIDEMIA,HYPERTENSION TYPE 2 DM - - ° '
31 DETOOaao USe ---t-'ST Oeat].. r .32.Itremale ` N . ,- 33.Mamar OtDeYJt [ .l•.... �,. Xs n•{ 0 Yes O Pr bablY 0 No 0-..^.."
oaian 0 runv++vee p.n... 0 , ,,-.;mead 0 rin.wAam.o:svaM¢unao.o 0 Nataal 0 Hanvoee 0 Amard O Panting lm'estcaual
Otq R Ame+aom 1 -i.snb.a ❑ua,ee,'amp.rvi,.;iti v.ew S Dslid,iaocasa Nd Ba Oewn < ♦
:34.DTs f Irpry(MatvDay]Year)_ _ . 35.Time Of Injury, 38.Place Of Irarry(E C.Decedent's Home.Casmflan Site,Restmra t Wooded Area)c_- :37-1.tcsy At Wark? i
✓ r ❑Yes 0'NO <
T. 3e; LOraam 011tl,+Y Sam . 38a. 0YkTaus 38t Sreaf4Ntflber I-. - 38d. Apt NO . ,38d. Lp COae /'
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39.'Desa'DeN IrFeY Orar^M 40.It Traupm'aton Wry���eaadIy - '
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"4'.; TERRY TU.Ge.EOHIPLeHmmAUCSEN;'aBsYeOElLDeEaC1R TRONIC SIGNATURE l \t `' J; , t4®2 CCertifying(CPnrayvAaOan n- = .
O Caa,a _: - O HaaSOmr
41 Name Address And Zip Cate Of Perna,Clxtlycp Cause Of Death: - t r 1- I f:',..•3, yL J 44 times N,r,ber 45 OTa CettZd s i >
T RRY GEHLHAUSEN. ,1020 W.:MORTON,OAKLAND CITY IN 47660 -.�-i -''3-, .,S 02000730A a _.' 12/15/2011 .
E�SLS 4a.AddhaelFaeml serv,ce PrvMer-i • - - - , t - w } L ' 4] AYas.. 1
49-sig,..',ae.Lisad Hein O'SCerS - w '�. /'•• 1.''s5 ' / ,✓ 49 For Ragit,b Dab FYea(efriy9at'nea) v-... - \,s
I BRUCE BRINK JR VIA ELECTRONIC SIG ATURE ..a.,,iir fir Ta,1Mf' 7=%� , tit ssJt c , V':DEC 222011 4 _ Y% It--;;:, `.•-
Sl Tr��•i;;.›, ,r. .-:.v>•[\ \»\J?%1:SI AMENDMENTTO CERTIFICATE OFDEATH(ENTRY OR ORIGINAL). \.Cam...�.\s.l'.\� .'v+�\\ it:�.fC '.>rc``>\1
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