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Death Certificate - Lanman, Geneva M_4/3/2017 R - •(^' c°'^� a.*+-s�wr < �.F..-+s-..�...+G ...+?1 ay i r-- -a INDIANA'STATE[DEP>ARTMEMT`OFliEALTH., '.t-4'-s• • 1 - CERTIFICATEOF°-DEATH ` ` ( = t:•.. �' (r � f ": , tocal.No 80000040 , - ,..,k State No '' ' ',tale - - "� a {.. 1 Deraiats,legm Nate(Post ltAedde,Last) to Maiden None(d Gnema) :Z Sar - 3 rune m Deli -4 Dated Death' pdmCYOayIYez) GENEVA uwww— — SEABAUGH u;. :FEMALE I-12:20 - 1 January44/2008 . - A Hospital - NO UNDEFINED 11 Fflty Nano(It b trateavc Give SbeetP C Herbst) - - _ tSPa�t1') .ST.MARY'S MEDICAL CENTER : _ , . ._ _ 12 City Or Tow,Slate And Zip Code - :43 Cantym Death ..L 14 Marital Stan At Tine Of Death ---,te�a- - = ' Divorced _ 15 Susivig Spouse's Nara. - - I 15a(U Wee)Give Maiden Last Nave - .18 Decedent's Usual Occupation • = 17 Kind m et- - - try- Residence Resider State • I 18 County 23 Ca _ 7- iea Ciy Or rase INDIANA . . . .. PRINCETON 18c Street and Number • -I - . _ iBd Apt_No — 1 18e Zip Goes I. 181 Inside atr Limits? NONE 19 Decedent's EWcafort I 20 Decedent Of WSpas Origit - 21.Decedent's Race. - tAllTite 22 Falls Name(Fest.Middta.Last) - :1- 23 Moths Nane(Fist Middle,Last) - :- 1 2323 Mmtefa Maroon fast thane --24 Wmna rs Name. ..-. - 1 24a Relationship T o Decedent - 1-24b Malting A d d r e s s(Street And Number.City.State.Lp Cade)..-• -- •z nine.. -yr - x 25 Paca S..Deposm - ' 25a Meted of Disposition. 25b Place m DeposdV(Nara Of Cemetery Crematory.Other Plane) . 25c Location-City.Town AM Slate , MAPLE HILL CEMETERY , . I . . - : 25 Was Canner Contactor?- 27 Name kid Conphete_Addrlss Of Funeral Fatuity 27a Funeral Hone Limtse amber -NO I COLVIN FUNERAL HOME, PRINCETON IN =~: I - . 27b Sirius Of Indira Funeral Sa-vice Licensee Z/c L caner Ha der(O Lm see) Enter The Chain Of Everts 'Case m !yahoo :lens And Examples) , 25 Pan)E Diseases,swiss Or Catpfcatinrs That Dicey Cased The Death Do Na EataTaCiro!Eats Aeon:raaie' Such As Cadlac Mast Respiday Arrest Or Vabnia Ft atio.l Without Shoaig The 0obgy Do Non Abbmiate Enter Only One Case On . Merral Oriset To Dann trmnedate Case(FiW Disease Or Condition Resulting h Death) A RESPIRATORY FAIUIRE . M . - .. •• Oa To(Or As ACasequence Of) . Sequential/5:List Coldtiss,If Amy Leadeg To The Cam Listed On B PNEUMONIA' . . . - . • lire A titer Tlie Urdatyig Case(Dlaease Or Sy That labeled ` WoTo(Or ASACOms}ace Of) The Events Resitting Deaa)Last �' - . - . C ..On Te(Or As A Cansequenre 01) ' D ._i- _ Pat B'Enter,Other Saork.al Conations CamtLitig To Death But NonRm4teg h Thetkrdalyig Cam Own,Part I , 29 Was Autopsy Refound? yL NO . 30 Were A:COpsy FvxTags Available To Comptma The Casa ct Death? NO - 31DidTala�Use CebbmeToDeath? - 32 U Ferrate 33 Mariner m Death - I:NATURAL - - . . . .. - 3.4 Dab m h}ry(MSOYOVyfyea) • 35 lime of tarry I 36 PIax m ' - Sae,Resterent Wbodea Area) • 37 limy al Wak? ' .-38 Localise Of nay-51423 313a City Or Taw, 138b ._8 - (7. .. - - I 35c Apt Ne 33d Zsp Code . - .as Describe Nan trpry Daaued _ : ;ApI\ 3 - ZU1! LOUT spM,aionhYYSP Y :.: -41 Sigabra Of Passe Cabfyrg Case S Deal, _ - .. - JOHN WY;M.D. 42 CRONE(Check Dmro c) by electronic signature CORONER -43 Name.Address AM Zap Cade Of Pasm Cart/Ong Cam 0I-Death I 45 Date Certda 46 Ae65sal Emend sacs Provider - - - GIBSON COUNTY AUDITOR - _ 47 AKAS 48 Sigaura Of Loral Health Officer - . - 49 Fe Registrar Orty-Date Feed(MauM rfea) . January/15/2008 4{� . . AMENDMENT TO CERTIFICATE OF DEATH (ENTRY OR ORIGINAL) -a -lao8- 3oi -o0 )• 5'23-oat -- . .-rat a.': 104.-©OI ` Ib?-Oat t? tt?= 00- 'S oat - v ,ILA p( } .Y7AR"• ( :i OHIGINAL'DOCOMD{T H�A.S A MULTICOLORED BACXGHOI/ND ON SPECWL OHRE SECURRYMAPER AND DIEGREAT SEAL Of THE STAT*OFINaANA ON BAC11,T1tATT� ..WRHSETIDltORANCE.TOva1.owwMFNRVRBEtLORIGINAL-DOCI sO THASHinorN vrtHiu cwwr%nay.enacaoe uwd owrn niece/ .- -