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Death Certificate - Clark, Paula Fay_12/12/2017 r k..:_.(rte. - .. c& ,_ii. .:ti ..4N.: i't,. 1 • • ' . : arc.. 'mil..C;.1i. ' •CL - iiTtS_.--c-) • -, ,, 1"44*. ." ti a INDIANN STATEDEP 'TMENT OF HEALZTIi ` �� �� :Local No�C000253 � �eDR`Noa0000006a1d2554:w� state.No--058896':+ �� si ),= A �..66e� vi Mare!In �,u_l}p� -,.1.`[j�...r�amn�{�ll eiI },�•s i11Vi „sextlivn'ryr QQar2,.�rylI ,�O()�� rn� 1 )Re.PAULA'FA ,di.AR °�'1 tfit )� . IWUARNEpR/IIIyI.er�,�� ,Sti F.EMALE4Vfirar.1235.AMi6`IrDUe12/02/2017 � :Pica et{ >-� IIIIM 1H 9�U1 1.�+ ^*�B i111Z-4 04/.13/,1938 ADDIS�O1NVVIILLLLLIE,,KY 1 ' -, 9 S Am'bd.FFcs m y10.'M Oe iOiccu to A HasO?at:/ � ` tot',Ieforo. 1 y ice A Hmp e54. 1l aQ V'A yi y.-\ t��>1`\[! be`' �. \ \ vp. ertie iSF Z p' DSAs.,, 1e-, :;.--.h.. ll-,---I,Lme F-..,:\� \�` r�ti�uet ®y✓a�eRwwa"er14,�u��nova u� pv:°�°'°iplra tyoQ'era > Tf�/!�t. ��? �.rAr1.�L ;.yf �t�-�}• ►1. 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I t� r.� � ''N.pa'�Apt{,tan?Code 1BCOwdeay umsTil r€6 Ilatar�x ��\ 1 ��1 91I t�+� iI!,5 I / 1IR i/�'�u i. �rl'r1 (t'0 es p' No 1 1808SHE . 0RJ, , / / / f = I It{ e t 1 }".. j I V .'[ L i I /. 4 AJ I Sr l 47670 b. 11\ 9'Decedegit -n 'fl 204DecedentO1FSspetOriPN ave 21CDededets Race es 6�LCI i:4 ji1��-x.611 :.'?\1 f ,. tq % �� i{`.. / tt/I e. `�t pi:. 9TH A2TH:GRADE'NOLDIPLOMA 1 . NOT'HISBANICti't ; ,Ct✓t) ,White .iin� a.tL ia- I "r6 22'PmNs Name(Foil Ndde 13.94 T( Jy�R" 44 - 1 73,Pa/e rs Name(Fiat•'MidGe;Last)•• 44 tle, jD-.i t r23t'Parent$LastNeme Betre FEsl Mamape1 + aTOMIWARNER.atR\`1► at •� �JIX,� ...0111-1-.. � FLAVIL WARNER;-. tt. / KILLIAN. >. +-�e r....... 2a'Inbrmma's Names' If'/ , '2<a'RelaamstaO�io Dersden 12ao)Mairp Adaess'(SCeet And Number:fay;StegZo Cade) s 1 v� E. v{urc L ,..I ✓ livaM.Patxh/ . nun- tee [1 ":�, ' MI / �' V' r , /�1A `lie e,. tt l�r .WESLEY.rTICIARK f.``: SON. 3049,EASTssTAFTOWNtROAD IRRINCEMIN47670�J, . Lb.. 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At �s V cri TERRYtGEHLHAUSEN l020,W MORTON DAKLANDCITYIN476601 tt1-l�rr/`,11r Ot 11 Ai ice ' L�1/2/�-0�4/r2�p0.�17 1lf 48 Addtrdne Funeral Sanm Provider `[���� 1���/ •ter lTc6,r y�!Vr ♦� r/ <) 1 • ' !B `D/'��5\`L' y r�eilec ma.a laral Heelai ter r/ {��\�J �1���� 1 4 Fa rrff ONy"DYS Feed(MadJDay/YeaN' > e(F BRUCEiBRINKJR%VIAlEI:ECTRONIC.SIGNATURE�l1U�l�1i '+ �%s�alllltl%�i�IUQ��G'r`DEG.04,4L2Qj7L%��Ilt1't�a. . R H ��i��� 1 uaO - S .<�1 s '%' Q� ��� �i��,._ <L BSONCO!!/t '1'0 DtTO \ 5---4(.. /� /SncitlL7+� ''ATTENTION ESTATE�.JhySvovoGl d�i(i�oVS eOtlyy�Pt1 %/�order to PsPiT+"w,rar gBep uu[S✓%lira allie461p1 Mt*AL j\�r%, -- ep�) yG/LOPIGINPLDOCUMENT,HAS'A'MULTI COLOR�E12, ACKGFjWNDO[ISPECIALRYNRE SECURITYLP,MER'ANDjTNEJGR_EAT.SEN!)OFe THE'STATE[OF;{INDIPNA ON BACI(�THAT! IC f i1W- IIING:tTURNS FROM ORANGESOYELLOW.WH HENN RUBBEDD.;ORIGINALM1rr`SMENT HAS'A"HIDOEN.VOID ON FHONTTHAT:APPEAS WHEN_PHOTOCOPIED ni_!tln�./ t 111'