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Death Certificate - Gibbs, Debra Elaine_2/24/2017 .. :,...._!„... .;,..vgrr.......autri:jir...2nri,7„,,:lir,p5equ • :•, , ,• : :0 .t_ .. i ': e• 1' • '4 ' #e' r-rc--' - t' i''''°‘-‘"<ralrli:,";12'"n!"---; Agea 'r-ri I r -,E) :4:4'01 ter'i• tre'a 1):-04;0•,-- )•:ere.-40-1,---aw:re-a--,%,r*jege--4jj lir:-%.::....=-,----1.-----411,-; 4-1,,-;:il Li::: riti------ :.>--- i , , '';,-,*,,i2,4k<uebeg.Ng;000446,. .=i-ii; :-...--;C;;EVR,146,..000000.524604.;J:les:411e.1.z..2c8tate t464)356604,11.:-.*.. 14;< ,.... il,Deppdent's Legg Name:(Fpscudcge,Laat) ir,-„tr--!)..),-!%-0%-ze.' %.4,%;545,:;:4-,Pr'.1a)PilaldenNanie!(If fernale)2 ,4()):ggrl 2: ei;;<'-=',/•77,I: ,:.,.finie q De40?-,. .-4::Date 9!Deati:kiNcihnpa!,,„•- r! !irgitj .; Ul!lV ::: t! r "c''%,' ,-10 -•;c1:7,?'''..t.52:!0;41._--5,l):F . rtf .:' '' , :::;t47-.: <t„ .4_„E„.•„..J, • .,1 ,,,,,, ,,,,,,...: fr ,,,i, ,„ ., , _--...c ..<,.,...--...;;;),;..twk..-,441,,t.,,,,I,„-,• ,----: , r,..•,.1....-,,,,,,,t,, ... :if, ,,.!-,11.:-..44 tc,..,:,,; ;-. 61 r, - Mr" ', .,..' 'Par m. ( ,; :Hours ." ?, ,-, it-nu!”:..:' .; ,,, .. .12/24/1954 . : PRINCETON, IN i i: I r; rr.i.•r T; 9 Ever in US Armed Forces? 10 If Death Occurred In A Hospital: ',. /' ; , i j ! ,, .10a I:Death Occurred.Scenewperepther Than A Hospital S y • .. "2" ,, :; ic '""; LI, 0 Yee:.0 No 0 Ditknovm 0 Inpaeent"0 Emergency Department Outpailenti 0 4., it Faulty Name(If Noting:1,ton;Gee Street and Nurnber) 1 ' 4 'a %- ' 1: ' 1 .' ' ' ',. DEACONESS GATEWAY. : r , r ,r r r. 's """. :: ' r ; , „ • : 12.Crty Or Town.StatefAnd Lp Code , • ' . ' , d , 13.County Of Death ,. - to MarPal Statrs At Tupe Of Death i ' 0 Married 0 Married,But Separated •0 Divorbed „ . . 1■EWBURGH .,'IN,47630 s • : • . ,rI:•:, ,„- WARRICK...': ,•;.: .., : •- 0 vt°7:-"ri 0 r)lky7Marr*S1 °Ut!"''' 15;SuMteing Spouse's Nate - . /, . 15a (If Wde)Gtve Maiden Last Name ; ) , ,.., 16. Decedent's Usual Occucaton ' 1 17. Kind));BusinessfIndusPy„, HOMEMAKER ' . : ; DOMESTIC: , : i •• ,., ,,' :,,, . „ , .. . INDIANA ,) '--, GIBSON • •: , „":.: -r. Stir:cc-, PRINCETON ,,;:' ., •, - -4 ,2 ,, , , / . , , : 1 1 . "r " ' : r - • '0 No 'La- 726 WEST GEORGE STREET . ' ' " • • r : , - ' : ; : r" r • ' r r t r• - i 0 Ye.S- " t r :47670 r , 19.:Decedents Educator,; 4 ' 20 Decedent Of Fuscaric Origin i „4 ' 1 •) 21. Decedents Race . i r ' ' , . r''' 9TH-r,-12TH GRADE;NO DIPLOMA ' NOT HISPANIC -- , r- --- .--", White ,-' -., . ' .• . 22 Father's Name(First.Middle.Last) , . 23a Mothers Maiden Last Name ;•''',, ' . - < .) C „ , , % .' ■ . ;% • .4 g % ; , - FRANCIS EARL:VARNER , , , : : r PHYLLIS JEAN.VARNER . : , ; , f STRAW : - r r". r 5 ,: i 24:Informants Name% ' . % , ' 24a Relatonsnip To Decedent r,, ..' 243.Marine Address(Street And Number,City,State,Zip Cade) % ' ' - , •, < ,, • .., - PAUL GIBBB: ,, ' -. . : SON - .• :. . • " •.. 300 SOUTHCALESTREET,POSEYVILLE, IN 47633 •"-r . , ' •, - • . 25a Method Of Disposrpon, % - 25E Place Of Disposition (Name Of Cemetery.Crematory,Other Place) 25c.Location-City.Town.And State ' ' . - , _ • 0 Burial 0 Cremation 0 Donation i 0 En:ornament . ) ) 0 Removal From State / . , . --:‘ 0 0.4;4.(S[Penet): ,/ SAULMON CEMETERY '• . POSEYVILLE, IN . , . „ ;re r25.Was Coroner Contacec?% ' .. 27.'Name An Complete Address Of Funeral facility ,,e -•- . 5'.ra a' „, „:" % 4 ' w 2, ral Home License Number: ,, 'a 'oyes' 'b '', "r ' :' HOLDERS FUNERAL HOME OF GIBSON COUNTY, INC.: SOUTH MAIN R r t: r ' - • ", ;0 No • OWENSVILLE, IN 47665 1 , , , - r - ' . t : • . 0021 r ': 27E4rSignature Of Indiana Funeral Service Licensee: r 7 N v • % 27c.License Number(Of Licensee): . ,1 RANDALL K,DIKE ,tBY ELECTRONIC SIGNATURE :" 4 :' . ' . , FD01010177 . /-' ,..t Cause Of Death (See Instructions And Examples) :-, " FEB 2 4 /017- -. . AFproximate,,.• . •.• ":,25.Part I Enter The Chain Of Events -Diseases,Injuries Or Complicaliths-Th'aVDirectly aL;sed The Dee',21.DO Not Enter Terminal Events , -Interval: Onlet 1:StiCh As Caidiac Arrest Respiratory Arrest.Or Ventricular Fibrillation Without ShOwing The Etiology:Do:Not Abbreviate.Enter Orly One Cause On To Death t %A Line. Add Additional Lidos If Necessary. , , , . - ! s , • - Immediate Cause(Final Disease Or Cond,tion Real rig In Death) A. NEUTROPENIC FEVER, '. ; :- " • , )0/4444Eer: DAYS'. a' "\" a c ,' " •' ' ' : GIBSON COUNTY AUDITOR- . \ : ,. •--SedUentially List Conbitions, If An)).Leading To The Cause Listed On, B 'PSEUDOMONAL SEPSIS 6. -' ,,, - • DAYS' -‘ , .., ' -,Line A. Enter The Underlying Cause(Disease Or Injury That Initiated) ' ', ''' ' '' C '' - . ti IcwmAuc'''''''''"c4 j.•t 'The Events Read ng In Death)Last " - ' C SEPTIC SHOCK WITH MUCTIORGAlj FAILURE. \ ' N ; ' HOURS TO DAY • :, .: :' . . . -.'_ • • - . . -,, Part II Enter Other Slunthcant Condtions conthOuung.to Death nut Not Resulting In The LIndeft4ng Cause Given In Pan I I 29.Was Ni Autopsy Performed? 0 yes 0 No , . : ,.: ,.: ' :„.A. .,.".:., -. , .... , •-..‘ ,:,• ,.• ..., Were 4,up,psy Finding AvaPable To Cornplete The CauseOf Derk? b,.,,,s -- i.k.,,,, STAGE FuUR LUNG LANC.R,A9TH OIS tANT METASTASIS > • , - I-, 31. Did Tobacco We Cent ute To Death? " 32.If Female: , 33. Manner Of Death: 0 ser wry:en...wePady.0 0"70n/0 Ime O.0..../."0 4,100;00.it,P,4,-,444 Warr%)Deyt C4 Orel 0 Natural 0 Homicide 0 Accident 0 Pending Investiijauon i 1 ID Yes .1]Probably 0 No El Unknotm - • 0',.env...4.BvtRerant 0 Deis 01 1 yar 101e0 D.:th (-3 10.0/0.01P00.00 W..Tn.P00,0. .. , 0 SuiCide 0 Could Not Be Determined ', 3 34:Date Of Injury(Mont/Dayffear) ' 35 Time Of Injury % 1 ' 36. Place Of Injury(E.G.:Decedent's Home.Construction Restaurant Wooded Area) •37. Injury Al Work? „ .• . - . . a 0 Yes,--' 0 Na , , ' . 3. 315 1.0.081/011 Of Injury-State - 38a City Or Town • - ; ' ;Mb Street&Number • . , . . . , • 30 Descnbe How Injury Occurred ' / 40 If Transportabon tnjury,Specify:- , , , 01>0000.00 OF......0., OP od..0. 000.■ISP00) ' . • . , . ./ ' , / '. - 41.Signawre,Of Person Ger-lying Cause Of Death: 42.Center(Check O. One) _. , . . ' AZ: N RUH CHOWDHURY:BY ELECTRONIC SIGNATURE r - ' 1 'i " 0 Cerufying Physician 0 Coroner . 0 Hiahlo Officer ,' ' ; 43.Name,Address And Zip Code Of Person Certr5ing Cause Of Death: , . . 44 License Number 4E Data Ger.-fled • . . . 5, 1 NAZRUL-I CHOWDHURY ,600 MARY STREET, EVANSVILLE;IN 47747 . 01075776A ' . 08/02/2016 .•- -44;441i onal Funeral Service Eroider.., " s,,,-. 47. "Aka,: ' : ' . ,:.....: L. ce, 3; :,-:---:,, ' , - -, , .,. -, : 49 For Reglsuar Only -Date Filed (MontniDay/Year) "”•• : ; ikICKYS YEA-GER:VIA ELECTRONIC SIGNATURE t --,rt. "r trzr .r r. i i r ‘: ' i • • • t r;AUG-03 2016 r 't •,.. r :„ : it>ki strss,,,:-."..;:s•sr-zr:,-..Its,, s, ,• .. v ; t. -, - . - .;AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) :- S ,.: ..; . ; .: .ri(;.. :: • :, Z,c. -:-.... ..(; : , , .. . „,./ '"" 2 '1 i . •' • . ' i : •'• 2 C / -/ ''', '-'. /. .;•/,...;,1/"„'..; 1 ' I SrPii Dirtra&^::i.-5<%." 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