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Death Certificate - Schumacher, Alvin_10/12/2017 ) .h,-(6--,,,,ens----,11 ( .!'1. t1 Fj7-7n , �7r.�, ,i'S i • • f.•/`tt && .1- ...-. - re----.42._..--, -%.f.�Ll..�. 11?1,..Ca.--• P1 "Ili"- \ ' : > - r tc i> C 'INDI'ANA STATE DEP -TMENT:OF'HEAL'•TH� w �\� \\���.. /•1 MI _ i' ,. , .,.�, i 111 (1 .CERTIFICATE'OFDEATH�1 , / '\ ,cr� %.,:, 15��/ 1}i• LOraI ND'000'18-1 :, \ EDR N0-000000598235. �I State N0:04481'2, s I.Decedents Lepel Name(Fret.NMma tefU rn / 1 l/' 1a.'Maiden Neme Nf?nae) G' yi'Sex it 3.TVneapeamr i <;-IMeaan(MOatv9ay y ''{I' 3 `I 1({`O I���l,l`1¶����//� tt1 �ifI1uh [�i r�il��'p 1 ALVIN SCHUMACHER - 11/W 11� �II IIS�/. 11NL� MALE /1.1:50�PM 1151 .09/.12/20172 1I .84'2111 'M?�f` >1.$( 11aTF9lU . =' itlll�"K IL:ntass Si E 1111r`07/19/1933o1(I\U `PETERSBURG;If N inU//11 � • 9 Ever n U S Armed Forces? 10 U Death Ocerred In A HOapitat� it 0 10&IU Death Coarse Sanexter�o ,Then Atosp/Mk✓ Iulili�� Ini 7- U S 1 .`Y'vl \ F' \� l \�rUw \ ti IiNdiFaaly U•0'D°aEerra Hana'C NIUm9 HanNLOl7fem Can Facty ,/\ LI i ;Dye;❑Na4'p ur)Frlwn 0!metier Elwp?cY Da{vrbam Oupment D D.ae m AAhel rOther``( )) "%. 11 fi .c.%//..I1n�w C": - \ f s.. li - r/ llryz-ThnTPV/Jliill d5//�' t(..\\ '/ \ ;:- .tea .n I '11 Fartty Name 9f Na lntaaaal Give Snot and Nmmer)%/71n nll//:In nnu S'M ,{n% nn }� q 1{� /y�t qt)`� [ni 4I GOOD SAMARITAN HOME AND REHABILITATION CENTER:-° 4111111011�ililC 11Uth i/�.�\lia ; 4ism -•f .1.1m1l e..--- /1�t{��11111" t,••••,,..\`.,Ccy a Jaen.Sln And Ta Code �< �, � i \-��V \�U " Can.YOFDAZ 1,1 �'1J �'1vM � V l°\A0\t\tV"Q�-L . ,] 1 . � - 1.. OO a®Namur O'ManIWBUt Sepaa's0 ❑DnaW {t�utll 1 el."' f n -II t �• r Y �(� p I } 1 1r�? null // XII `E "^°0"e°%p Na„f Mmnea'J Vmmwf+,% OAKLAND CITY?IN 47660t F, a�ii1�1�(?%1n11i� Na 1� 1a GIBSON�erI tl fl i '���i° ..cep (` nec5��spacef Neme 11 r- •} _0/r/ `ul('[v j)i{Ise wiName"Be_rore F� \ '" \ 1/ Ua++M UO q.)21hal t � ...Miwsfnne 43•LINDA SCHUM4C EH Rlnp� { b%�.�I�\�.,i�II�% KA 'C�111\�� /�-,f1i' ROLL'G_jRINDER%Y}n-�� D� STEEL'-MILL\v/t?{ : (�ie."Ref;e. �sin' 0 7! 11�f,)�l� i} � DU°°"y�%/-� �:�atY(OrTwm- U � �I � I���q'�?�t�y�j � �°��S is Fidn�� G j! i rtret_ T1 I 1: .111 e j`I-`° 1 � i1 � INDIANA\\ J \; GIBSON". OAKLAND CITY i�nt'< ,s°°.tAmrrN�a�w�er -. ` �{�,�� r �v- �� v q �� \yea roLNV`�- 1e.:zp c°ae �et ww cY yya e l' -44,1 l 1' --:':-.-=. 1 1 {}} ��}{�J,j }( ��� �(���j�}� + ��( X44 p O L4 Qom®Yes p No 204 W WEST STS Az<IF III 11` 1111 tlW {eilU/�l�l[l1U/.r_L x1 .291 11!{1 l/�3111�If I� 4Y 7660.ZVI11 t5�� ns11' r(: 19-DeaCenff Edumbn` \-:s�\'-.\\ zOtDeceaet a RUpelc Ono; `, ' zl. Demaau°Rece� \� '\\�' � { ��i HIGH SCHOOLGRADUATE OR GED� it t p,v un� _ 421 W( ;.�J�l/"� � t COMPLETED �`^ 1ii11 ft .---.1;1111..1c: NOTIHISPANIC..k15 11i1 Wliltee �I1tIS1 'i,et-'///11U[li �}1� MI1n f} 22.Parente Name(First,Mid,Last)ir- ✓J'l'1 -t1U U `><X4 1 23•Paranfa Nallnee(F Frnt.t\MMiidcDeei4Lefy'/� Iq G. a .3c 23aPeem'aLmNana B° ter F-itMamp°1l i.. '-\ t 1F kt, i' • c.:0 . /\� `�y�� , \ -.. 1 � !\�ti,'T ,1 �� ili. L}le to 1 WILLIAM SCHUMACHER'rS1n 211a �ia\\ /rlln- /. SARAH SCHUMACHE� .w\\�/J ENGLISH \4}/n ? I� i,„„ ,,L , 19 y1 7} I'✓%� ilii fllr 9%n %rllt 1111 q JIB-a ill( %1 i21t a�}r it wt i 4 � W Itil r i i /11,1 * , LINDASCHUMACHER + .1-- 1, ✓�\ WIFE\ �� 204.W WEST.ST,:OAKLAND.CITY IN 47660.II�I�.G�\li�l�l.�.�;,ni([4 r\�\\> ,\ v i` '�..\\\vi�11\\\\Si9n\\�\�i�zs wce&o:+EOSno`o "5\\\��'\\\`.... \�� �.��,:1\;1374 k.�.UCS.a\\ • l 25a Method 01 Deposism' a / , 25h'Plaee Of Diem„wn(Name Of Cenatery.Crer:awy:O8w Place)/�'25c 1 ta+'City.Taw,.Arid (,I r t ./ ❑®.iN ®CremaSm p Davaon❑Ercan�hnl'eN 1% 1{1 l/t l �L'ytf.v'v � �7 G� y a ` GU l// '1`✓l`// IS{II1'��t ., plRe'roval Fran Sta's i. ' •1 % `\ >/� I 4�1 lAC%��\tt"\ i4`/ I�t . ,,'� I�k�� v� U / • 0 oi,e(spamy) . 3n >\ EVANSVILLE CREMATORS.\ l&. EV�ANNSVIIL'L•E;IIIN v Lih ��; a .\�\\\.S. '� I 29.Was Carew CaVaaem 'r -27'Naame Are lcmld Addee<s>r«janal5ver i1i11�n�Jpll n-rAl}Itlr�//A 'r;PileArgiu C, e Falaal RoWjeTse*mi"'••µiltiU�'' aa ,-111.' LAMB BASHAM MEMORAL'CHAPEL'■INC9t226 EWASHINGTON STREE�IBA 141 AUDITOR2)`.1�y,l 1 :. DYee ®'NO �s11 `U U v v" U U Suntan t✓ , ✓ IN isee: \I111"/��l(It� +'ifil/<�\ i[IN1 C'�ti1-' / �aUi�7 �Ntrnb�/ 111[. FH8300o312:� tl /. n• 27e.; Of Ideate Falaid Service lir seer\\\\j \\\\\�,�;„,����� \ (270,UCaalaa Nutter(Of lawn°°).K�\\����-w�y s.' t JERRY LEE BASHAM BY°EL''ECTRONIC'SS IIGN❑ATURE'lll.>V, „nn a�% FD0101658911W� 1nh\�lr,'4t \-/'/ '.I - l rc r i 'G 1,4 ',e' t '!U!"--,411111 ca91P c'eathi isr ImtrucBs a Md Exameln),( 11 ,.11 1 t% App i'ini lil{il i I f l.E 1 - u, f 1 glen( d eDW n ass 11' 20.Part I.Enter The Chain r ce.), sin Or eta-Zi s;ib Canpf TkM D?eae.Caused The Deaet Da Not Enter Ono Ciui On 1/`� / 16 D Onset 0 el Such M Cerdx AaresL Respra'ay Arrest,Or VersnaA:r FlMlbtwn Ydthdut 5flowvp The Etwbpy',Dii Not AEbenala.'.Erga,OrYy One Ceu:e On * , I. \To o�m�� 'a- , '6 �A Add Addled/Lines U Necessary. \�� \v •L Vz �� �v p �\Z J V �� \ <i 1 -) r;;;;.--3": It 1 r�/.2l l iD n /i ( �� 11 p�p R .. p\ p\ R a '∎,,,1 "-��ItILii 0rn 111111 11Utn�/J�111111 a-0.. �YrEE� I Mmetla'a Cause(F Dcsease a CaglWn Reside' 1p India-U-0, li ACCONGESTNE HEART FAILURE R _ 1 1 1 r qwela..n C�weKr r G p �<.� _ -s I /° 111Lh1811iIiI RC11111- rt ; *. [a ' L,11T/ ,,ii i r 1Sequer4aM List Landman tlAny Leedrt9Tosct Cause Wed On\B. MYOCARDIAL'INFARCTION(t L)sli:' �e lli 11` C \\ELI WEEKS 1)LneA. En.e&Thiundimin9 cause(Disease Oi inAry-,Treit 4idiatetl� �p� {a" „. ( ly"y {r{pr, •••���a �a � C��Tlie EVerm Resfle9GDeatn)Last / i1 / II���IIR IIL1)t1 Ya )�1111106.111111B ;�1 1111n� / 4� wefa Nacen.�e op V �/ r 5,:z->..3-le V ,,��1{1 1 �i r'i,� l `' ��} �i�'v`�t C�1�'1LLt 1�' Ol IL'�11-��L 1■ it1�\°� ter' 7.\'�;C�+\\ � 1 \ D a,.�Ri� / `� U` `\\\\l�fC�l�' '8�,'r'�S \\"\���^�.�.�\\�.tIKV\\�� :f 4 _ _ :Pan lL Enbt One - '^^teb ea Na Re W` In TM Cane Given Pahl 1 28th MA Podanedi t 7 -111i�1i �� .21111{ v -Iq @ Underlying Ic.<g<,t srl i°.�nyig<a s �����D,Yess ®No���i11iR / 11 n.. 20111 f 1 ii '�C a Ft1� - 1 '1'&`�,11ti ��'jj/TT1 `1 a 30.?Wafe F Aaiaee T° The CausapF111 P ei g t iTYPE2 DIABETES MELLRUS .-.� ,�y///�Ii�i 4'�,�lf•.i�/w//2U�I�U�r'L�.��11��r���. Ian�<<�i\�<�ir i�lQy 111.1 -i«ant r%p.Yes1 p'NO . 1` 3,,o.Tee=Use Contribute To Deathi', G 32:�` i--c°r\ \\\ \�virc �1`ti"�l�\\\\W41331M.me Of D°°m.\if`/.C�`l `;+1_ \ ,r \O Pta.' f\NO \^s ❑'_°"s IL aPer a&trim a wn.0'aan.aw'avwe n'al.,anr�6%: NatorM W.eracd°, .I4cOaart\�p'P1einL 1p hxeftip?aelt / OYes. Pm01,p Na ®uNawm l -,O-i/ant\\!%O 1fc1�u11\p!cJ° gna:.�itl:.psam:p'caw Nae.'"'Deed-/-ilit,a,teiflmi;".". i iD to OfI 11t 1 yf I / '-rre CfA n.w!o a,.a re re,.o.3 Uti L% -34 Dn 01417(Ma1TFDryyyee) 1 f 35 Tne a lrpry // UI :3e HaceOfnilry(EG:D°mdees Hana:Constnnm Ste RS• �lNixbdAtm) 37.-Ir;uy At Work?/MI / ° 1964:::Y l / Si1- /� r11/ �'Ip!/ � 1)RgTL/�,4 'aC{,(I�I�,f�j�[y�i�4� ` I{� l ,'DYai�(�,NO �� .s ..:, \ z_a_.: 1 ti >>,,...,_i\�`k �'�e ld_" C„'h_:-.. '�Sc�\\\\�. \U ,„ , C'\-raL�� .�����.� 1 f ", 38 Locumahfrry-Stn yl \+ Sea. ca A .38055Feewlmtw vJr Gr' 38c ApLNor 380.,__ Cede ��- '✓./�ti,'1,tl�� t�1h11� .„i s�� Week" Twill//., 1111; ,%Cell . �� I{% 11 t11"+ L.a1V �(Ill�lil-( i1 l�Il ill/ .1 7L 39 Desmbe HOwlrfuryCmmM i t\\,y 71.-: \ \� v'1` �U ,40 IITrs i.crj$ y�y\�\ ,r� i;5IuS\ , , - , 1.1::; -:',2: r����4�\ ��n ` Ol ��n s �Ai 7/liR�1�Ln��/t(nV �. , 41.ISpuWra a Pena,Cartryrlp Cede a DeYhrF IIII(/-,2 F71�f..com g F' g y th,l rCSa(Cnark thrOai//. f1��1 yn 1 i TERRY GEHLHAUSEN BY ELECTRONIC SIGNATUREUw1reaa1 III: '/ailQ '5 9Ut!®c:itrylna Prink n:tun0 �.�1k(1 LIHeHealtlsl" �1� , • 43.Name¶ -uf Mal Zp Cod°Of Pars Cemryrp Cerra a Deana �� p "'S Q L 4,I.Liwna NUM?��u 45.Dabce9fiW��L7 c TERRY GEHLHAUSEN -;.1020 W:MORTON'OAKLAND CITY; 660.11a 4� ,bri - 02000730AICllnl/// 11•09/13/2017- t `,1 4e.'Aodtme Funeral Senre Provider.rt' :i ^IG'�yll U 'S U J - 1 L47.•Akan U U 1 Q 1)il }. i S > a ti 1L. ` f)'f:caVAAA�IIGC�N wit-AAA-12 a- �A _ ��trrtSr• K. �� l l . 7 ; 49 $i do(Lncel seem 015w ..- �L:AV�/1�i1AVC/ p �t� F -'49,Fa Rglsear Only ;Dab Fed,MadlYeati .. A� BRUCE BRINK JR VIA ELECTRONIC SIGNATURE��iI to 11� qL[�'.t.i':111( ��111i 1�n�lar6EP 13t2017%//Il 4 17.''111' �� //J!,;' -/ ' F. V1l!r//x•11 n1Il AMENDMENTITO.CERTIFICATE OF/ATyH(ENTRY OR ORIGINALIM MI4%%r�lnI7111.2/iliUinl`�JJ/�.,.it17Si 1.,/1111 i„. , �, , � pkr �� f-- ���, Ion.•• 1 / U /©� % rr� °1t1/e�11ik ^^^jjj �� /�/7��/��� iJh r ..'`,��`///))) (``1y11ry`' 1T,yL1' 1{ ,1� (9 1.-9 I V` ▪�0:_ -� di it 0` �:e 'a ark Itl% tt iODU �� � Vs. / Tun tl\9,-- iii1h�H, l% V� `- VVV 11„ 1'1 U State Feem 53395 ATTENTION ESTATE:,The Soda)Secunry fl¢ req�e°ted try fhb state apenlY,et ceder to queue respprnmdly.,Diicbare n'./emery add tMra 15- Ee ro perlatty fa retinal• �\ L% .�iT. r r. m.N HASAMLiTC✓RED BACKGRii/_ItiN 1 rPdJ/IHITE ECURnY AtERA TE GREAT; FTHE STATE OnU/ANA ONI BACK 1 v�) l ORIGINAL FROM O MEM HAS A MULW WHEN ED,BSED ORI IND ON SPE-aAL WHRE SEDDEN ,PAPER AND THE GREAT SEAL OF THE STATE,OF INDIANA ON BACK THAT hIl�1 �;.__, _ 11\I I Y b7. Mir FROM ORANGE•TO YELLOW WHEN&BED.'ORIGINACDOCUMEM HAS A HIDDEN VOID ON FRONT THAT APPEARS WHEN PHOTOCOPIEDI.0..<f.'.:tone_ , .%1 �- .. 'r was..a9s.+.ea..aa.. u..4 i..rao..a. .... - _ _ _ .a<A. .+e.•eo.a..mi....c+�..ca.. ,.a