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Death Certificate - Wilson, Jerry L_12/7/2017 L - ._C t.111r�C1 c,h Ci .1-J._ /\ 1 ._r_% • t!1,l YJ _L_ri�.11 .11.E .I1i. .LTzLI_ p L a r' >"C3a�INIANAElDATME OFHEALIi'rl �j>j :`�y 3 .1 1� i. eii,{tr+ 1 �`a4({! _, I' CERTIFICATE OF DEATH - , iri �� S �V T" �' 7 ! /�4-- 1- '1J ��4a{ �� 11 U, - tlfei rl \,. .. .A ��`�i��l/_``I�ls ���r -r %e U ICal:Noa1D00 2380��"�71 EDR:No 000.000611a1t792-��\. a state Noa058529�ti �� r 4 ;11 Decedents Legal N•me(Fans,Midele;Last) ; s MlaFMaider Name fler..are i•' ]]I 2Sei 3 i e IXDean- 4. �© �b Itl �I{� ®,,t t •l /, n Site OI Deat arlYVDa ff 4� 9ERRYIL"4WILISON %AFB elr itli re'.e∎ 1 i . � 4 MAL . �O� . 4J/2�/2 _ r r � � � • • � MALE 1 �� `�I➢✓,d,1f28/20,1:7 . ' 1 10:1f Dealt Occurred In A • { y { �.spa(,DD�4 my Somewhere ONad�AHTeaI ���_ \M1: � -,.. .^ ,a _ '\`\Lam �\ q .®Hospce FaciCstrooadrorSHame 01i1agic7rwlmgtem Care FaoLY�R yO( LYes ❑t9eRiu y❑Itpeoen O TergtenY Mi �.Y"m,M^, I r -aM'"�1-S>.5t' i k \1 � 4� {\tJt r LI rE 'klllif,,IBNameQiNAIna seotthYeStaeaaNVMe) i ti1,7e..pan- Ba �6 / � 1 p ,y,NC � y LAE iHPi1EW lfI � p �gs , l �q � o � t2ACiy a TOe14Staw!AMZ Code Cd+ty Of Dea'h L, ;Z..' P " .y k`l.. �. -4., � �� ti3� ��V'U + f ♦�tr,- t41�Dibinny t y e.«1� �% �. ; i.�.�s+T :1"...1„\\�' rrr''` � � T T®IMnmed❑Named But m i I I,1-.R l� f +.,.,iini' : ❑iF. EVANSVILLE=.IN.47710/%:{f �(I /y t L 4I111'i��� t{%'� "�( Vii✓�Fq� ��v� q 1� G�v`+d�� "`fir(` ((;,� .VANDERBURGH d + + "�17r •OfBut�❑Imw»mr !f( 15cStsvtwk Spouse's Name M Cr ,( t - `.� 1531ast Name Bel e'FVSt Ma�rage .�� �t, y6C,DeccUm[s Usual �C1dv\ � �k lL \�'li'�o ' o�oeben .�.9.q n- •aaa;amewlmu=m i� CONNIENVILS a' I t� KUESTEF to T1- i'TOrT n ELE_CTRICIAN•P - .:,%�., .UTIIiITIES i1-s :It- 1 A( L18nReskence State • a sla A �ea!CountY II r 19beGtr Or Town q / 1 a 4 ♦ •a 1 1 \ .. •1(d \1 f "! ( { ] hIl /1 1 1• /!i I NA ti S_ '1, \. l_r/,N.'. . ' .V% 'i. s���..��,� 7.. %1-,,(k%S." 1 ..9`...,11%-((�� GIBBON a\.� FORT,BRANCHD vz. '*aa�t '. ��,.y��x+�'S\L�t �a W( '18cvStreetAMNUmber r 1, f % � T .j 1� 7,-.. t°;{��It>�, •(^ � - n '160 APL<Nd. G18e, lip Code I 18(�Inslde City Dmn E( �� 1� 6'?% 11 s q � I 1•�, i �j �j t�'\ t®v6; El No ' 6153 EAST1750 SOU4 H .. i, ._,!1.,o i _. I 1 mssigin • - %." a..1� 2,--'4 . I _ •`4 Lei' 47648 4'Iti':,., 10 y9coecMmrs Educa5onl `�1 �. 120%Decedent Of Hisparc Orly v O n z1-n Decedents Race - HIH;SCH IOLgGRADUATEIOR�G D\i1 ` \, -v+y ,.n t., - i`1, i I,,* ��`[n 1'1 ry�'rZ�► `41 COMP_rETEellil /�lati 'emit.d Nell HISPANIC'. �� .t 1!toe-e4 White . �I Si,'�. 1lr./-Siz( LM Pr 1 i i.,�I 1{ci 11 C ,22.?rents Name-(Fest,Utio a•Lart) 3 1 z Th.. !b:IP' • /�.1-*F.1.M1 t-is ..i �L 123rFarat's N; -'(FUSt`,'Middl=tazyf • 11(p 9j +23a`Pare�s Last Name Before First Manage 7\ ' ..^%a••,,,, •• •Sr .4.',,\ /4L.`!f1'r3 ...-%.{� <s'. lr '\. 4s, a! A.c. \ `'� t� �� ROYiLIWILSON ., "t i �� Y��y JQAN;WIL'SONe\/ fa\`.N.t II ST.ONEi�T� 4911$G 24Rnormara's ame 1 I t24a,Relabonstiprrc Decedent 124b!MaSugAddr (Street And Number:Ciy,'Sw.e;Zip Code):e I w CONNI I�fl�S CS .`��Ir�i -�+tSDL� M 84 S1C75 ! �+00l {16HG ANC 6 '%+`V �w N CONNI6WILSONt_ .[ice.. WIFE^ 6753,EAST750;SOUTH4EORTeBRANCH,iINL47648-.-� ti_ 4 �` ^&t'1� ni t` -t-sn ..--i S�P��isrua«orots-ra. ��1ti���\�11JL,.1s `Q �`v'��vJ-t- ` p a Cr 125aty.pefaod011Dispou W, II aaWSIt1 25b`PwceOfDisposixn(NanremCemeteryCravLry;O:serP )�,125c!Lccatm-.City,Towis tSStS e: ',1, ILI ®Buial ❑Cremation ❑' Dala:on❑tEntomGrerd { (' q+' t S % % / . -. 1 i STISCASICTERY- '%�ti^_ F,OTiBCH I o +26 was Canter Canoed? 27!N 'And COmplete'Address Of Flsteal Faatty, W 1� ®H ., .�� 1 i t� t AI,, 1 r :�a�FuMalHane I:cmHNUmbec4 ✓� tL1I� �� Atlt1�1 �i1 '�i 1 . 1 .�" ,�� �- i!189d[ I]Yes ®No ' ,&S a 1�n t 1 a STODGHILL FUNERAL HOME.I l 5001E.PARK,ST! 168�FORTLiBu CHNIN 47648 S F,H109000131s 4 ANDREAae Of*BaneTtaal Service ttoensee. t & 1L 'a 27c.V-IrSe;Nanber(q licensee). t J ANDREAVANN?STODGHILL,�BYAELECTRONIC SIGNATURE Atl. - ED2140000591'•..i. a5rr 4 is. 19]l u 41m�ut /?s Cause •( -rane lntioct)r qpq EZampla)i ti..' i 'I"'Ir Y. fApproamate%11� p !n`Ih 11es,OrComi181� li ause 4vo.A>PgtE.�-ermine!V �,� ete�„attOnset `2_.Part L EThI reSUR Of Evm'E w-tO?.esy4yales Or Cotne Wt oet Thal Directly CausaE The Death Do Not EnterSemural Events 5 +d R,Sui AS Garth%ArresttRes}puatorL tOr .VertrtaAm'.FirDatim VAthoutS The E4d °� ;N `%.'.,- , To Death hovvg' agy:Do Not Pbbevtate Erder.ONy Oise Cause On \\ /\ 4AY�vie.�A3d Adde'atsl Liter lfNecessaAf1e'gj 1-q F { i-{ Oa \ ediatePcadsa(F rile cgirtaryetioln Resulting In Dear'',I ..t\-- PANCYTOPE1�. I Y./ 1!' ui{3►14 6ii 11 ?1 -•it .1 . ' tswwtea.�-,w-�mc 11-20.17 ....!'Ii Qd 10 i 1-l' I ; . •,, V- 1-1 I , L r C-. bseauenualylkst Concktrons, If 6nriLeaerid,:to The-''Cause Listed On 4,•••1/4_ pl eA-Entt TheUnaeeNyigCausa(DdeaseOr4yisyThatIndiated 11p j�� i.1.��1 - �°A Gaga Orr f art(F ,� r -] r10 - ��( ` Tre Events R +ng in Deamy]ti}l O j i _A 1-4 iII IPR;/��,i ,`;, 4_41,iY�1l✓ �[{�� i.�..,e<91L IK s I s er riilltl�lJ1111' 11 e l r,..4l Y j �C (ii J4 11 er..t A i Y .,...,C.,". .27," ..�m..a..v or.S ad s V ` t o %t 1 e--....:.4 �/ x\11 4 Yom` .�\ �4'} �5 •�` ) �� • �-• {11� \\ �' -�4 (�L `'t "ms_.+, '. >i. i �\ � �c Dom, 't\ C\""-i. -...11/4'... .4... t ti. 'v.Y \a t� y IPar'VEn.e1Othe , mCdntnbutin t DetrtnBut Not ResiistgInTheUndeyugC se Casts nPart1 i• 129]'Waa'AnAmopsYPerformed? '." �eII fill asr aq �...p�.y.e taooa>,e„ w.v�. o ssc �`/ aoni c.asr el ahr>Q IlL ❑yes 0INO NEUTROPENR LEFTLEG CELLUL[TIS,SEPSIS IT/POP,HOSPHATEMLA.1GENERALIZED,cIEAKNESS, u1- t3a:Wtre'Astc yFautrg Avaaable To Canplee Tire Cause'of Death? !teaV- HYPERTENSIONIIMMUNOSUPPRESSION RHEUMATOID'ARTHMTISSRAYNAUDS OISEASEICF� %j rznitvoraatluc Tao .%Grant uoo�.'a n r�❑`Yes.i❑TNod 131.Did.Tobam Use CaYeidae TO Deaar7�a r32%If Female � "at 33%Mama0l Death i!\ i-C r \1'Y ,^ O W 0.� -J Dreg'0 OW MCA \`"��. � �I �� rwsvw>. varerr,v, CI- n.r,..swmaon ao.r. ®Naurel❑Hartv�M ❑'•A[ddea 1-P []Yes 0 Pmba l isdi ❑P41 WMI D3✓ ❑ etarg Imestkabm i !�D �417A1%a a�rl(c. iQi1nU aav< let+ �+en t - LGl(lT1 tl�>!.JdnstYb�6t#1 ill�l ❑++!A.o�K a.nywev.,.T wxe,w�.ao >,® ❑uwvnsn.rrwvam m.e.wr '�/�,Jt❑'�Staade❑�CWd Not Be DewrtNnedQ/p.'W1rh'I��ja(li e�i 34 Ore'yOf lqurniAcc eayNer�^�ay't A -35 Tan.Oflrptry' l/. i r y38 Place Of (EG Decedents Home,Canoucvon Ste Restaaant Kboded Area) 37 Iryuy'At Work'• .St° ".i >r 1-H �4 h 1 Y ��i °. t -, f j(�sl'7Vye � '.y �. \\� �� v `:0 daa\ �\v \t{ 4S 4�\aes 0-No 13a1e� L.1��;[,�eeelyytt/���5/a/`x��.tn][1{[1a1`I,planMrsstaw 11 �� -Mirk caiaTOM,- �{{��1 j(( �/f// )3Brsdaet a}R,ber�� ,i``� r /�`I ��,y��$a�'t NOV ?�,I31ap1dl ztp/eo//ae// 111*� •(Mier hi->,... r ,,,,, f .. ��-i1�.'J.-I Il i\. I L1C��4- A_.• aa1a.4 (�;;_`L f�')D� 'orry ?cuj[ 'e ...-5-4-01�/ ` c �i �^ ii- lm,ll rr�an���.P«wCCCtmI ,a ..t - - .. ��;Ve` QaItOSllr�✓121H114 ®lT /11 (_- QUE Ied0i-FetNTEMgcasePtPaat s:IWCASen!avu �agea wy_ � tiaa34® �;Pm' rv)orl Q�,/�W1�tL6 _QUENTINIBRENilEMERSON,7BWELECTRONICISIGNATURE ., IaHearnasde- (5 43 NameaP4tress And Z+pl:% Code Of Perm Ceruyig Cane Of Dea t -, �Y r1 L 4 t`,- J'J�{T131f`[��1y\�Y1: V^M��[l�l�crose Numb}er 4.5\Date Cefi5ed &t,QUENTIN,BRENTIEMERSir 7861.Sa PROFESSIONAL DRIVE;EORTdBRANCH:IN47648 ( , -a 01027038A1:11_� flll�L/�Ill{I 0T7M•7.:''46.1Adcabonal Funeral Serowe Proilder.as 'vim 2 ..'_��..,A r` .--j:J.-.°::tSzl a\j 1. .`\:14.-:S ' CsS 1 : 'd�4<'d�i:�t c� 'f, t� {t aj3 ., ( 43 tz'gtaore et the Heal019ar 7 � 49.0 Fa Reglstra a.�o voanvsq>���r/�Q��. � [� jam- ,'q �r, . y�",.mot ao(.(. rytt..-13"7;1 .4,31%/11,... _3•ROBERTtKENNETHI SPEAR,IVIAtELEC'TRONIC)SIGNATURE @I MMA Sa& ilh1 111111 Ga, E . a . a,�.vaa;; ,St l, LPM/111B1res&MH111r60-1ER111111[7Q 'AMEN^^^OaaaMw EE fill]TOCERTIFICATEOyDEATH(ENTR�OR ORIOINALI �d er∎tne [tirerelgCIBigV��aII.1:41re r r. -601, tlea q ©pp;Ii (ira lsD11 _,4.11 /i/4141 4.����� % 44'41 i ! ����t am a � �� t%,��� %��I.�, i . - _ �I 4, / _ .�, L State Form 4'1-- 't iii ArrENTK)N ESTATE':The Sorel Seaetiy C s bark SequeYed by Ws slate agmry n oidet:to pursue respp-pp Sy Discbsure is vohagieso(�� 1-y}q n>tusab- '(i�(�ai(4�L,,,,D�iF/ aawkCIs LIMENT HS f UL BACKROUND NSPECt tteECI ur .SYrgDTHEG DIAS0;B DwGwAL DOCVMEM;HAS A MULTICOLORED BACKGflWND ON SPECIAL•WFAS HIDDEN ID ON FRCINT E GREAT SEAL WHEN HOTOCOF I EDIA�Nf�ON BACK THAT •�2UIWAR... eTURJSFROMORANC.E•TOYELLOWWHEliftED.'ORIGINAL?DOCUMENTHASAHIDDENVpOONFAONT.THATAPPEAR$WHENPHOT000PIEDPf'-1111-4?__`