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Death Certificate - Hume, Thomas R_3/6/2017 K 'ii`rt3 .r)err 1, .;E) , < INDIANA STS ATE DE TMENT{'1F'HEA!TH} a ``ter : CERTIFICATE OF DEAL! r tt ) ' , • 3 IF 1a,.tu, 3�r IL f. ,}I} ` 1 t1 4 , } `SL. } i :, f r'1 Ys }F " loca►No`000043 ." ` ' EORNo 00001 0561747`_'" stateNo'Q10116`s' l t-De4edrh L.epl Nor_}e.(Fak ,_ t+ •, hams OI aR+'•) zSm a T c Pyffix } s 4-Os aDW R +M.a) - Y ^ s (... THOMAS RHUME=' MALE: 01 00 PM a + 02/1912017 -55 x 't. Mom Da» !loos ;..,. minutes - . .. ,Hmptd 1, ^-- 0!Cowin Fanny ®'Skadenfalbiu Q M,WgkmWlm44.m CamFedtb <;1 x Ores'®NO QUNda+n D.IItPasat O.Eln.oenyaemromin Ofism QOexda,MtvaI 'Q:orr(Sp!a1Y) .:�, _ -, .11.^Fa[Ey Ne DS Of Na'Inat J5a Gse Shed asd Mfle1` - -; - • } 1709 COTTONWOOD DRIVE 5:;tz-Cty Or Twnl Sae.AnOZt C, t„ . / ;13 Cary Of Death :14..ManalSaoe AI Tor Ofta•' GIBSON- • Never Qut° uYanlad❑ PRINCETON'iN L47670 N t111Qead j^.1S SlaNVtrq Spama'a Name .. 15a Ins}Nws Belaa Fud stmrp. to•De4eOrta Usuel Ooappm .t]. IGnd IX Biawsst� i • ANGEL:HUME THOMAS .` ".s • : ”. ENGINEER ASSISTANT UTILITIES : ' ;1a.Resitlnaa,Star 19a. Cuaty, 1eb.Cdy Or Town. L„_ ., . INDIANA GIBSON PRINCETON t8c Streel Ard NUMar lea Apt,Na 190...Z0 Car 18L tnideOaylan.Y? {I709_COTTONWOOD DRIVE ' - - 47670', Dvm-DNO 19. OSneama ... - - 3) DecedriCt Haorm Olw 21:deciders Ram , HIGH:SCHOOL GRADUATE OR GED 3: COMPLETED:.. ` . - NOT HISPANIC : White Patents (Fit;Middle,tasty: 23.Panne Name(Fast Mldde.Lath 23a Parents tad Napa Before Feat Manna LINDEL HUME } . ._ ” - , JUDITH HUME "'. - JOHNSON 24 n nc(s .. -24a.R.Iriaunp To OemOeut 243.Mat C Adrpa (Steel AM Matt,City,Stab:Zip Cosa) ANGEIA ; z WIFE- 1709 COTTONWOOD DRIVE-PRINCETON IN 47670 1 ZSa WtOd Of OtaposRm - S.Pin IX Olsptaal(Neon IX Crn.twy Crrnamrl.Om Ram) ; 25n Lnmtm Cy Tolm,And Stela ®6rvls0 cilret r D Dretm O'Erlrmdmil - r Q onr speofyt_r` - MONTGOMERY CEMETERY. OAKLAND CITY IN . r ` ZB:Vhs Crab COltaaN9 21. Nano NC Complete AOmast IX FlnrY Featty -.� '- - 2T9'Funeral fqn tkama rtrtat: _ I COLVIN FUNERALHOME INC 425 N MAIN ST. PRINCETON IN47670. `. FH83005671 2T0.-S greare Of CNane Final Seneca LiCese: - _ :. .. - - Zle tipoln Mu to(IX tJmlee . , MARK WALTER -BY ELECTRONIC.SIGNATURE • •-' FD01013010' + "-`?:v "r; .�- a •'Cannot Dealt(SNlsatrucdana And Etannb) Appratrnsa- .^' 28.Pall I Ent=TM Clan IX Events-Omens:4yriea,Or Cando Witiorb-Tat Dtaay Caused Tie De tt Do Not Ener Temm�l Evaus . lutrvat Onset Srh As cent=Artesl.Rppietary Airm1,Or Vatiatar Flludletion Withal Showsg The Etkbgy.Do Na A6tre ia'te tree Ony One Cane On To D.0 - Innedmb Cmna(Foal Dis.sso&&Cat ni Resting in Death) A COLON CANCER WITH LIVER METASTASIS rA • a ar- 24MONDLS SeouelteyList CCr}dtims tMy,LeaSag Ta Ths CaweCued On.' -0' - wblo-" r+�em o>: - a Lae A,Ester The Unduylnp Cara(Disease Or irylay Ttat belted . t Pe4 Elm Opw i •: BW Not Reedtrg In TM Utdryllg Cause GMn In Pelt I : 29.Wu M AuDapay PMmnedl $ ;A `.. `... - _ 30.'Wan AitgeY Fndhg AVIIEEts To Catgleb ye; 1E1 oVea QNo �` ' -31.,Did r Um Contribute To Dead] If Frnda i aHMan IXOek - b Q a.n:•swa.:.... 0 Q w aon,o, alsor D Homicide O Arndem ❑Pal d gY4,0404 11 • ❑va.D-PleNa ®r .D tt?;o is D .� •.Plegmt aneui,./.• • . ■ y.;'-• .4: 4 P••ra; ❑wore plate fiaeao.eimmed • 34;imdlltny(Ma14vDayA'ar) .. 93, Tine CII WY ....•. • . ...:._ _. . - s2 W7At WalA'J > �. - ❑vas•,=°:ONO.-; a ffi lsnikn Ot tNaY Sba 3d city QTown • ".. 3Ba APLNO 38d $Cade" 1 e��aa�;i— 4� nTmapWtm lNry may' ' �1r71111e IJn..ne.v Dn..aw ws.e.Da+-a..•_} - X41:S�(mSn,'Of Praon Cenyg C.+MOIDISt - _ • l 42-Carte(Cmde OnlYDre) 3. MANGA-DEVI KODAU 'BY '` - -- '®cantirsaPnysician D tamer: ❑wm+oscd- - q •1:43.Nrm.Afars And Dp Coda Of Penal Gotham Came IX Dente _ — N. Lorna MNtar 45'Dar CertEd. MANGA DEVLKODALI 4055 GATEWAY BLVD: NEWBURGH`.IN.47630 - . . 01072479A - -- 02/24/2017,..-:' 48 Add4and Final SrNs Roeldr .4] -AW 48.'.SlrflOatnml Mett}Oissl .- - 49 FarR ,,OMy tm FMP4 GvV yfeat I Q BRUCE BRINK JR"VIA ELECTRONIC SIGNATURE ` t z« ,;' o >. -'MAR 01 2017 -AMENDMENT TO CERTIFICATE OFOEATN(ENTRY OR ORIGINAL) - T • {D 3 I:y--C�? _ y.. 4 \a L•ELI Z•' ti r s� _ r �vx a/Irti;.. ..sue �:-"� 1! (t <{ Slim Fgrn llltT'rEirranaBgu7pINA DOCLINItwaaq is •-•- •-EOBAytidaDUND ON VE al• SECIRITyPA AND,?-IEGREATS ACOF, HESTAT`QPeretATOFnf BA dt ONGeia ta._ - ENT HASAM .. 4-ED B,fl!-. ULID ONS SEC. ...Y➢ER"A. THE •- RRV OFN- 0 0IrQFINDTANA 4TN84CI-l-c r AIL\IN •1LSL 2-t - • - 0a Sal! 11 . • . .TFIAT.. -RS WFIEM- O D..Pie'DT`./•- .?!711 3r�.el •<�T,B-R!n=:T• ,r.{,'T.fr£"::--•1�VA`.tvf.�.^.M9=-.a:'✓(sue\"�T • • . r�'TMN^�`:.�h�KYil^�c-.�.rs'%'fr'R�z"•:is:1.^�-eF`tc\i F_rT �`F sl./fn:2