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Death Certificate - Glouser, Waldo B_4/13/2017 t; dr "'''%."2..,,It- 'A li".....„.2,-;mir---- tf:„---:.; IND A' • I •, : :0 ..„-„; ..,,.. ',...5.:,,,..,I , : ..., t.„. I afte,...511/I • ... I •-• it-Er,,,,,.5.3. !Tip v5.1 L 4:-..C:11 cr Itt .7,44 "-- ' "SI P'SCERTIFICATEOPDEATI4 RESUlfiiiiM"..;:r" _I .....,V".-cks, 1.--.1.,r s' ...." ;' ,r i -,,. .'s k-a,''I-", J.,:c111 ;- r i AR 6-, i .4*-1ES:11Wr..:11W-;11Ail”1 tr, .:.---4,7*--•"' 1 in 41!I A09185 r '-t7"12:t:st Ldeara 0001g2-.E(.'- '' ,.-, 3 -...,EDRINi.il i ,,-- : 0000005. 8 95 „ 0 * t lf C._ '• State!No:. _ h.-r . 4.... ...teil 7,- r:'' Ills .." " .7 . ,.,7 '17 i I rs.r5.5..i: „..-- . suLlMaidenNamshattecnesq2;57trifii. ,,:s.x_irt... ,,.?.i.,-.57.0,,..5-.-Niccist..,onAni,..Ny ., „ ,1 N -.:rin3ecearica Legal Neifte..plt4s8Irai,t,eAti'v.1 Itp I trip,:t -il, pij 1:-...4,111 7 on vq"....-Adiki-c*--til ,dui ,:!, ,,: ,..-...,,,prpe7-14,41,..4111,1p-:-.9imi,T7;12. : 0_,41Mtit..40-,44U4,4i- SK-t,5„..,... ..ct, . ..,,,, ...441, ,.bil 45,41 .--" .7 ,,,,N.11.„..,. . . I. ,,,,,JIII ,-WALDO.BROWIGLOUSERiL.k ;•:-.. ...r..>-. -r...-_.: :,,.i.i ''' ".N. .■847.undefcC‘...;k:aur. rip;''.‹. ..ef eikm::".:MAlmonthroal:E yNSS:H.00781071AM, S....,cminfo,tfor0F6onor/22/20,ontI0163.<1/4.72r ,. •,s,,, . qt,N90.rh.t....', 149,.11.:-.11: _i.e.C.PlYrtnft .,-... itisin ?•-..fb-,_it, ImPmtfr. .4,r,,,>....1,.. 4 4 N.N....1. . 4 4 „::. r, , 0 . „....ii r„.„1,,, , t.... 8 iEver MU SfAnned Forces?i If :40 II Death OccuTed In A Kral:p,-4a7+1;;..7,:-IElitr--.aij i•1034 np_r_tc)??0,1.. spiy.f.T....dr.„„.airliptv..,_),19.Ein,ii,„Iv.v„...-,,, ,_...,; ir?.:co!fr.22 Art,......:;;;;,,2, (,:s....?-r---„4--- t-.--.--,..:3; ••----\s","41' 3-e-N'ItS... -,-, -Rs-,-;-.....‘ts.•,•:. .1:1110.4;kcyzacm.Y..--41..J,,Dt<ctg°15i-t'grn,°•"•0, 7"7:' ,"\c,c8•Lt;rt,;S:..÷..,•:%.-s,e4,!;;;;.t:;,-,<-4;•;•• is- 21xe;1:1N°'El u%"";"°"1" .,a,,,,-."46`44-,, -.°,E7419n-1. ,:„.<, .?"`";‘,...r.thrt.---'ser!,,,,,,i_P,..°"-s..--`!".. ...... 6:0;(.15),Lity-;11 :"il-,,,::',:i.• 1: -.-% 1 ..-_-. .If...f.:›....,:.1;-:....,,...,sr,,.,,,,.:,: ;..1,.. II.piaciName at Na Innixxn;Give SreetanaliurnhepW:7-,3 .4..“,.. v„:-t .1 ....I7;,Ft-5-?: tri.:,.. •5.. z •: •, ... t .. k, , 7 c....c,..t . ,,zix... . GIBSON GENERA(,HOSPITAL ; .;-..P- .:1,. tSX;:i.r: .-- . ._• ..- ;• ,-f 13:,:,_ :01:..0 _, '----,;11.9'...'s.-tt:011.--";!. •"C'',1:, ' --'• - 14 MantS: jsAlThnbOfDsath . ib `',1 '.at?I.?,STIILAT<QrS, 1152.. '''{ 'CI 4.! 11: -:..ji? ' . .1 ::..,4; c: .;,....C<A1)...":"..:c.. ''',./". ii.f i r "".. '''. .1:11 1.;n:Sea 0 Marrikt,eut,Sep,a9Y8.31.0 151vor048 -;&, ( ../.,--.7-8 - :tt-t^.t., t/..-5;err t ..;".,, ,'/. 't ::-.. !-C-\•,. -''. .:: n ,,.....-'' `'seisC;'- -,:1-', ? .,/;''...e...: . Q"PaA49.,c V *:14-siitd;:171-gi.4+.'11,-S) ■■' PRINCETONIN;M7670:::%..:'ve . den Last Name. ttIt--1 v.-- I t13:Decedent's Usual Occitheoon • „. •17.:8MH,a 1114ra. V:Ipt!”FITY ,,,I .:.• 1;‘: 15. Saittang SCres 1.■arn”1-'1.24 -:‘""‘ ‘ '7Z-2?::(1::ij :;:'S: :'--(1"Te):91thi -•<-,;.?-; ', '< ' c ‘% 'C--- • ::• " '''■ • -'. ' '-';'' -..-•^<: "-t.:`,.:::'-i ':.‘"- g : ; :' Th ' • -..r: , 4%! .?',. . - : 4- . • ,, c. , -,... i •-•: = . •-.: .. Y 1 ; ,-. , '' , : :.-1. . --:;... .,- : • .....kirpe,:2-., -; • ! ..• Jri'r;?...'- hi'; Z:'•' i.:: ;: FACTORY . ..7 , s % ' FOOD ...• ',.u.-: '‘' • -t''' tH.z."'.4 --,..' i>.- ."... 2 • ":1c2:( ."if,::•... It.: -, S?eetktNhilflbet -- nr- • ,:, 'f ,,-.• -,, ...,:, , i -.. ,.-, t„. zt. :--,. .:..,, -•,: .:..r . t ; . t : , , . , . .. ox,,!nal.„t:i9 ,.::-.. 2989SOUTH 976...WEST:1:.; ; . . , ; ..: . ,. ...,, ,..f:- .::...;•, ..2„. ; .; •,.. , r.f,„.-; .,.-... ,: , ; , , . , 47665';•s :.:“..-.C... ......-1,:c.../.. !;i.ti?IljeC,68nrs ,.:": 411;-°,1,1e43,9_1,,,P,F0,72,.:::; a,,,,,,,,,,,,,f—,,,,, ,,,, ,,,,,, , , . . 7 s._:• „,. , HIGH,SCHOOLGRADUAI GRADUATE:OR.GED:,:<1 t.A.:......-....."4...<:,..*I.K.c....„&.;;;;;; ,.,k ----`4,• J .;...--w.„..<4-.:4.(a..:_.t..-c...;.•,,,,,, 7-4 'N't,•., :- •.....,.: .. ... ,..„tt.... . .../. :"...: COMPLETED i":‘!.;,..•%-st:fliVe-.:-"tri -.:7■:1.-..-s.lt.;!.11::i k• .715. Wiiiie...57.-":81: 1-.5./..5:,--5.357-5,::. -8.5v_..,..55,.,-,.,...:t.„..a......; i -• 22.Father's Name(First Mode.Last)t• 5 -t. :1- '," r ;" I Ir":.I."i I.-.."- --;: l!lkitilIi P/dde . s'"?..1.:';:.r,I, 2:34 ki?".n h;215ti:t ti,5,zytti"5”,(if II :It ,i`, -, 5- •r r • ?!.-c ;:-.444 --,>. t '4, c •; s....• :-' '`-,..,1‘ ...!..,.t.-z ..., - -..... '• ALBERT'LEE CLOUSER : : . "-.. •' ; . ,. . ..t.s. '7.f,--,--•: I: --, ALTA:MAE GLOUSER-- , -.....;;I! • : : , ICE!:.::rnn,......,„: ..--.,.; -3 .., Relattezthe To Decedent-ti•%5, 24o:Mattng Address(Street MO Ntmber.City;State,Zip Code)c .. :t f. ,i, ::Z("01Y-'2,-1:;'7.:J.42%. • ; RUSSELL GLOUSER"- ,. '' -. : •1 : BROTHER, . i-----z.P.,<,-:“ 2989'SOUTR6751,WEST;-OWENSVI - ;I 4 65; ,, -C., ,„ .-;... .....: - .: ‘“%-..-...--: .;:-.,;- , .1.-,;,_.-4 ..:- .L.S-.4.33:4. s.,z3?..S43:3...3.,----,•..25 n. diiiii0 ;IgI4E'r;g1;e4,!kr,KS93flt."4-ic4:_;..7.2.4i a_S , .. - .;%.- .„., 25a mercoof Disco:xi=-."% • .., 7 . .i. 7 I :25o.Recap!DHpissLocth;(1,70temeteoGatIrrY:911(P,I,r-e); i,!:".;!-e,cr,53Ifiir53,...1I-An.1„:., ,, ";2,. t, ; -.:- 7,-; ::.-p,;..*IIiI:IA-t,,,,:• r. Li ijig:Cia 6,6rniEl6.0,-.. 25610 Enurnirit -" ,'..,... i ---.1-1;:!.:-..Y.:,,:::-.; , :'..-.L fr-:' :1:--5? - rer4.....1Ur„,..-4-;. 11,,E (4,:::-.-1: • il =1' , ; Elle;o:;:afFroM&nth: %. .: ' , , :: s- :%. ,": \- .-,,S,:st AZ35....v•-*'3..1,!.,: •?.:1 .,..„` ::::15.; t?„--.."S..%7Y817:L53:...1A p pp 2017: .,:i...._ --- - '' • " " ' . El../ANSVICLECREMATORY.--:....,- Wir.•,::-.:..4r:-./: EVANSVILLE; iNk.tmrt-, :f.nI.,... :. 1....1. ..,?...-..-.1 i;::-.-- 11 t 25'Was Claner Catacied" ' '' ' .27' Nan,And CW1PI-t-t-a-fl?T9,9.1FUneral Fa-c1:K 1.-...;:$;:: %, ''1:5-T.'1/44:,..d;"tlIgi-. 4":--%:trICk.,.. !!:' „2?& te-7147-1-,,,,1-;&7::.;:u3gr.5,S—' `";• I . fis. ,:, ,47,,,r 7 iHOLDERS sgUNERACH6A170F,GIBSON.COIJNTYI-INagil 9 SOUTH',MAIN'STREETA 1- -5 ;N.: „.,-,7.157.cifft-,,-es..".,4(.7 $, t. es;rti;79 . ;. - .: OWENSVILLE,I I N'47665.-4j i 1----;•3-..1 II r. ,itr,-.,..}k, .,, .th ...._„... i., ,Ir -II K.. .. .. ff., ._00. 02.1 7%4-Pi.....:k c:: 1 ir2z ' 27b.Signature Or!Wane Funeral Service LiCenSee.-,,,,-,:''..",'"'!.-',Z.:-•";r1',.....:"f..rr'Zi*•;:ffi;r11i'lliln‘.-.-: r;-f .7 7::)ii"; .271ceTV?): '-ii i i1/41t,WAU di 71701ktf-ifta:i,-.- 7. • RANDALL•K DIKE BY.ELECTRONIC.SIGIJATORE!--.>t pi, _-,..,:,r,f.,.,iii..,-:' .1P...11. z.tfr..... :. : ..). , '`.•.'-',..,-„,... -.'"',V.0 ;1'.' ,,•,."'.-....-'"11•• .:' C-C.....,.Ctgt:Pf. Tiatt,-!(See IrIZMd,i -s Atnd -E1-7„.a.Titt)V71.1t.C .81e.; t4.5.,;-t'I. ';‘,-..j.'''P. - ''-j, 1 :..";.tif4P8`?tale0:Et; ,- : .28 thartl.'Entei;ThiChlinzOt Events: Diseases;tnpnes.Or ComplicatKiiii,That uitZtely Cautl;The Death.bp Not Entei,Termhal Events>,,•: v",. t---, 7,%.,-., :It ,..,„: Interval..9rsestA. :.., . Suth As Caistiaektest.'Respiratay Airest:OrVentristitar FittrAlation tAritti4s.A ShrOVAht3 The Etic:4602:Do Not Abbi.,,,‘1%,gilt,95ThiliOratiOtsiir On y-•. , . t.- .. „.., . .t.,To,7_46 it„:,-;-,t7., t: ris Liner Add Addtiohal Ones If Neciiiihr. %I 't t; S 't, <SI& I" • tt:".::;-. 1(e.a;',....4.e-„NirAitg -.7..,Er...;;.2;1.....-(:5• %.-ci?....,' • - - . - ! .$ • • • ;•.f.z.na.,...7::.....,f. frnrcereiai6CaUse(Final Disease Or COhdlOots Remitting 19 Death) ', A: CARDIAC ARREST.- - ,- -...,", lac; l. <", ,'"' % ;, , "I., : 7%.:itrtilIMMilt "i4ijVC. 4,4 4 k, t%▪ t"--..,:i • -. ,54 - , :: • `t.' ‘. .-"-,5-15 MIN,is:-:5- e, t. ;7, Secpienhilly List Coria.Sicets.t It AIri Leading To The Came Listed 0A;ci:7:•„,„,,,,,,,, 2„,,,,,,.,„:„..,,,,, ;'-i paler;77".-tetter,,r,,,04, , ,.,.,_. .„. t. , ,,,,,, „t;,,i..„ : .,,:m...,;:; i,:t.c...c Line k Entir,The Uhderlying Cause(Disease0r7Inhirit Th4tinit.latra • .. „...„2.iisc5;a41--Al!t„.:4,:h!l't ,..-q,:r.:;;;Iditt2.A.::• ..▪ '... N , L' 4 ■• 2, 1‘,..r.,,:Ir.:: - •"'VC.,.. c;"1,:;' :;I CORONARY ARTERY DISEASE Tbe Events Restt, hi Death)Last.. • :' T ,. : .: • .' :. r;' ; C."-% ”Iff.:=“11 %-cA;-::.--- .,-• ',---.-;;L t.- : :.. • . %-' .'. .."7 i 5. ;Par;ii.,Enbir OSH•SOrti.tHOISiCffLi5EISS55818DhiL83-D81(33 But,Not,Resultro In The Uneerlying Ceuse,Ghreh ithpert,I : .? 28;, s!,,,,FIAT:AP,I"P3L(iettrI7 7 ,:. :::tELYSvil--rtilii47;:itY:Tr-77-17,...,7rt.";t5"-.5%tir "; I '1;:ttt llritt."."(3%.;&;r#Scht-HeArTfi'lltj Et1iLlffOcae- Lt• SI!&' 111■ 1<;Ct;-"/.'" 3,13;Wet?.. ILFin„dinget„ 12We" "°-9.8 ?at-fet.IAWi0 -:.'• 31!9!d TF,astr,11'thief,,-'°_,*"tra-I r-- •s-_"a4111.4411'4,thr.44%111-0;, To.,_Ef-c---ffinifirimp'lirtr--1--;arirri ,--,-4.gre,;•te--'4:It ica)33:.niMatr"iai AIRFIricide'l 0-',A‘'-edrant"),6P.eneingITNi5.4:tigricc; rat L' ••--,....----rWi{ 7.-, n-r`,,• ."'"-• . •irtiiik.C:‘.4a 1...0,,,,ZILIZ(.‘724.11:kt.".71,4 I' ' -,..”4.1r.‹,...1.41 7:4".."-ace..."Z 1 PC<SZ.I -•,.,!..■••• -net ts,--vr .•----A:Ai!'L,',77.,-.tij 5,,-st.,Ato T-:.<537U , ta vas 0 Prot..bly EN° Lo VAITIPArt 20,,„ ----,,,,,,,,,,,0.i,T. ,ss,as.,os.i,„„ 0-Ls „,shway.e,u17,7 tve sHi5a•S3-5-...0 Sumvse 0 Could Thot Be Determined -,-------14.S--"C ''■ . Decedenrs Home:Comm.:Lion Stte,Resimmint,wooded Area)-r4. tyf'.14047.Atrnwetyir%I.r.t?,, • -34.•Da C4 Ipany cMorar143,31Trar)1;51.,,',1152,3;: IL8,5:15,ir„Initp,';:5:•tt:'1.55 1,Its.-?,-;:tt I, .1„;...4,1,,i18!',):,: ,.., _,I,, „.....; :-IS 5. 5 '5.... .t• ',....,,I,t/• ",..„l<.25 ki,42,5":71 1:;:It..-.. €.- - L-- ,--I.* y••• .....15:4"," .,.,,,k,' ,,,- -,,,,,-- -",:-.7 ,i,ji,„0M.,‘,4„.,1,12, ::: 38.Thar=Of'Huy.Stam t " Mit -.5 tilt t..: :38a'Oty Or Tom •--, :i• ":"-C•11. .7.!31?%: el 8N521thSft 'Th"" i•I"5 't - . '• . - t ' " . .rt"..:'",:.'" `I :rr;e't 5-:.38c Aj3tNo .< 38d ZipCode '';' t" ' I '" -' ''-: ' "'its :-,--."' /".."-"t-- ': ;; -, ■ •ij"-- i . - - ' "-. -c --' ,: -4 , ---: ".'f...". (-:•%. --.^'4'1 s ''-- "-.. S :7, ' 1 ,.,-::,:;-.>:':`.3.1..;•(".",,,,,f ,_ . -. . -. ,; ,----,--2. ''.:4).---:, ' "i • • 2:,-,,,, g.-- 04 '...rtlit7;ftls-, AC,LtTrarsPP.r,tethor!Y*.rY•AP•c4IY%;r ' ..".-., , i !E-c.",,''...;■ ;i 35-Desatoe HowIvivr%OFarel,„.„„..I., 1<kt L'; -.5 " "' " ".t. -: m-7:1- "-s,'"": ".:3I-7-1.i‹.,,1:525.7,:e5v,'.:Lti,PI Ovms•c••••••,0r^"Aw 1--873rna.1--Ice.:1.,"-",.1 "-.:'%.::::.8: ."4:;: :7 ' s' '... t‘'` -C. tt::...v 5.-- 83P,nrii-7.*-•:.: :,•.-7;7 ..... .;.-SS:>.-., •"...i..1.Nr:SSTS,..•;9..--:,;)"5.4.,•tc.....z.:..:::..--..-...'zz.-.....,.. ..-., 412.sirese.:of Pena,cocstina Cause Of Death::: , I 1 ' - : -:-. --. - i ,,\'11, !;',74--i.}:1„1;l i V41 ;.4ecif.te.,7,(Ci*k.9otP^.°1;L::1-,ti : : ,,7 tit; -Ii.ii:Qirri5W,7 c:. ROBERT D:iBOND1..BYzELECTRON IC SIGNATURE"sz-A14..•zs-3.:t•Ir'?•`::.4-..-•,:.&:1......e".z.."..-,...E,c . .....e.2-s IN untying PrryscanC•4 u _„ u ri 4:7444.;_c-:-e :.3., Date Catted'.3-,-.43 Name Address And Zip Code Of Person Certifying Came 01 Death t 5 ..,-•,,•?.:,(Tirtat',1 ri-e.5.,:5 Trier:I r.,3at,* lc r'r.r.III -,...i 5::-...1 :<.,!..,;(-.2intir-timule-r(---,--;i t; ;; :, i • .ir-9-,.0P-&4-i•4.1r---..-4-1: -:=J" ii.. -.7.‘4,:fit ..-j-... -6Idg0 .6-2A,-: .:: . .'',. : ::oes-2.0ie--:.4,i -=,f ,..„• RbBERDDYBOND685YAICSTREETPRINCETON, IN-47670N tN"...ea.!..:,.. it,_ -,=,.....,.... A,...- ... .:..., 47...A30: , : ...: ,.......11 s:::. Thcoi . .....; r ,-.. i.g./ADonal Funeral Service Provicler.15",-,51Ii"ft% ,q,.""tt:',,,"; :•-c,(!t-Ar.I411-,7,-SIIII:t?,:C4.1:4,1 "AI f-R,..;%.;III fr.v"iti .1.1";;;:.,(',F;;: I,,t-.,,- s,..i:..::i7 t:i,„ il II ig...:?,„:1 1&.,-;:,ilt, .C.":.<5%..i...:,.t<fS24.K441.kam41.4&-%5 \LI"-5:`-la•-...-&:"..: .7. -54.7fr 7 v75--...../3 .85."-Lsm-t-cs,-1.7. ..,.....- ,.<4 ..,4,i,LF t-iFtv..1 .t.nr oniy..„rcia;, ,R.,;id 04...i. pia.):„.z. T.... -: i"43:1179:1'5"risire-":992Titii::n441:1;: ffi"jir Jr:11,W fP ---i??,--fIfirili 1.;%":11171*5:4TP";:i'Ltt;J-Ilisr23 iileilf J111 -Ailifilin tv BR_CE".BR.....13/2Viik ELECTRONIC.SIGNATURE. i ....-‘ -• . .....• 1:2......!i . , i .-4:. ....-F. ...c..I..4...s. ir,. i",--.b.Y.,t;!:;-:3h%;,:t>,... ?"1;-.S. >,cy.. .,,`;.:, .,..l.57,1.:—...,_ ±,7->"-._■‘7 ,AblEtIDIAENTLTO_CERTIFICATE OF DEATH,(ENTRY,OR ORIGINAL),.:::.....,-..v.f..c..,;.:.•,.7.7:r.i.ke„.„:„.,z.;K:!...,.,5F.c........_--tmpi....c‹..s.... jr.:77r,e4nriteitc....4c.i f -,... 4,;:rwi?;:irAir*vgialty[9.,stre),IiitviLlfr,--65,.q&-,-,...4"117,---12,4,71:qt---,c,...ur.k.c.:cdr-gtir ,klittritt„.41r. rt,---,-y.)...tiips--L.,,,:::rititer,.,,,,,,,R4111,1,,Ir:,,:_;fie4..)11 p-)41s. ,......- if ; .. ,,,,,,, .;-/-:--,..,,---..,;:1,1 4-..,,,,, ,....: ,,„ 4,‘ • r3-S,7-'"A:?,.-:---_,_33-,S41;W:,<S- ,`'.... ..,.. , zi...`..- : 24(RUSSELL:GLOVER". 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I: -.5"....I ii, FIN -e •,,„,- , •. ::a WH NA 8: C.:C*101CA, ••0.2 MENT s ... T,, . el i%0, • t 1. .•-P - PH• it-_sr 64•/..-W3144.re4irt,"4?"...4tzt .1 jrCia'&W.,`-i.ka7.kT-•'>&:'112,:tThvCrs.A . ID , p . . . c.kaa!ricit;s:::-Z•tc;;IP'`- 73l- cifa-.T■rgt-gr-iftcarrp:s).1/4!"ra