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:B,ReeOence Stay 18e,Goumy /� ,taba City Or TOm r-' I{ L/ :'{
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�j'19 Decedents Eeweon c>\ l.\\� \20&Decedem a HUpeuc Ongin% .:.' .21:;D_ecsenrs Race., "% C ”1.1W v
HIGH SCHOOL GRADUATEOR GED� '/1�Ln�'�/..^n i,';;,����p ��p A'' 'N�ti �, A v
1' COMPLETED111`.`, t' I� I 1'? NOT!HISPANIC:La'f�//�lll� VWhite ��il L: /1. iNII. J> Ls:
P fT 12 Pamrs Name(FUSE MgNe Last % U (!r 7 �/ 23:Pests Name(FrsUM.ale-lwse/ n 1R ,', 23a'Parents L st Name Belay Flrst Montage
IC'CC�� WILLIAMHENSLEY • i4 ;, /t��� �::,i��11 \\ MINA'HENSLEY`� A� i- \� . f PICKETTn,. /m \i
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q SANDRA PARKER a t. 3 r 1-4'^.\.J DAUGHTER /416024GLENWOOD DRIVE,:PRINCETON;IN 47670 I i C arm
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5 27"ygreve Of lmare aneral Service l censee:�YsY \ \\l" W"W\\\WW0 4 nr::Lease NU:me(Of Licensee),' \,-, C*oU'
BARRETT W:IDOYLE;BYeELECTRONIC SIGNATUREltR` 'S: ' 1 F,029500009:1 \�%1 �9, �1,/lll
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4 28-Pan I Erse The Chain sp Evens -Diseases alums Or CompEcat ts That OFenly,Cause.3Ttte Dean Do Not E- s /I
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'� B. BRONCHIECTASIS\ 420 YEARS '+�,
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1� KRISHNAMURTHY1'.BY ELECTPONIGSIGNATURE�S�USI��,Mltl '113' VIII p®'car.+nraPtn' art*Sil lO ce'anarll�i O nerna�r li
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L:11 KRISHNA'MURTHYII 685VAI•..STREETfPRINCETON IN 47670:`...). n t. f131 1 /! 041702 3188 Alitu in _ .4 Rn.06252017
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2-t‘b:e Finn 53395' ATTENTION ESTATE The Soaal Seasay a n Ce'+tg raquasfa.M this sine agerry•n di.'a to puree reapms�Bay_,Distlosttre u voluntary and there will be no pesky to ra(iaaL'?r pO
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%',WAR N I N G:OR)GINAL DOCUMENT HAS A MULTICOLORED BACKGROUND ON BPECUL-WHRE HIDDEN TY PAPER ANDTHE GREAT,SEAL OF,TNE STATE OF,INDUWA ON BACK THAT 1` 1�`
-TURNS FROM 0 GE•TO YELLOW�Y/HEN RUBBED.ORIGINAL DOd1MENi HAS A) ODEN VOID ON FRONT TMATAPPEARS WHEN'PHOTOCOPIED. x.11' ems/ LL�1{.
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