Death Certificate - Robb, Shirley Sue_4/24/2018 's. INDIANA STATE DEPARTMENT OF:HEALTH' ,.
r �? CERTIFICATE OF DEATH r+g •
'�. .Local:No 000672 EDR No 000000635842 state No 0:159901x1 l� " .O
1.Decedents Legal Name,(Fist Middle.Last) 1a. Maiden Name Of female) 2.Sex ' 3. Time Of Death '4,iDate Ol Death(MontrWay/Year) ?✓-
SHIRLEY.SUEROBB ' . HILL FEMALE 09:50 PM ' . 0327/2018:.•'':f
... . ' 81 Months'l ' Dan Howe Minutes FRANCISCO, INA1:; ;snit'1C
9. Ever D.S.Armed Foncesi- 10.11 Deans Occurred In A Hospital. 10a 8 Death°carted Somewnere Odle Than A Hospital' ,�,`yi')'t -' - - - `�•
• •.h;'•0 0 Hoe Featly 0 Decedents Herne
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❑Nursing HameiLmPimm Care Fadtty ` .,
❑Yes:'®:Nd Qllrtkrgwn ®IrpatKnt 0 Em«gngy'Depanmera axaben 0 Dead mAmval p donor(spedt� ' -.'ti' • t
11. Fatly Name.(It Not Inset/con.GNe Street and Number)
ST.VINCENT EVANSVILLE, INC `-=" '�+tt)i;,,.r-
52.City Or Town,State Ana Zip Code ' 13.Canty Of Death 14. Marital Status At Time Of Deal•.•..- 87.5:ti,
®Martied0 Married'Seri Sepaate -'Q:DNIXted'
EVANSVILLE, IN,47714 VANDERBURGH 0 Warmed ,0 Never NaniedA0:UnkOwn; ':
15'Stni g Spouse'YName 15a.Last Name Before First Marriage 16. Decedent's Usual Occupation c.c., 17:Nina Of BUsvesskgicdy'.t,-:40 `�5•
GILBERT,ROBB • HOMEMAKER . .r:'tr" DOMESTIC - -•'•l '• '%A
18.tResiderce-State 18e. Canty tab. City Or Tam . • 1•6•S(�)•, c•1
• (r/.2,7„9•;•••r. _ ..t.•
INDIANA' GIBBON FRANCISCO _ 2`S'":+'+tt< .L'
18c Saes AM Number 16d. Apt no.. 10e. Zip COO- -18f.;edge Gry Umai 57�
r®YeSP0 No i,/ ',
20S3RDSTREET, -. 47649' ei-.r_ „1. d ;
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19 Decedents Educalon-' "--;1 • •20. Decedent Of Hispanic Ongl • 21. Decedents Race
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9TH:12TH,GRADE; NO DIPLOMA NOT HISPANIC White -r;: ual •
i2 'Parents Name(First Middle,Last) . 23.Peens Name(First Middle,last) . 23a.Parents Last Name Before First Manage
CHARLES WILBUR HILL LULA HILL ICE ..r a -r
24..Informant's Nome 24e Relationship To Decedent 24b.Malleg MNess (Street And Number,Ciry,State.Zip Code) .' -•a' y
GILBERT ROBB : : • HUSBAND 208 3RD STREET. FRANCISCO. IN 47649 YC` 4 , ''t
. . ^. 25.Pact Of Dlsoesitin - ''11,'11!..... 'Ar z'
25a Method Of Disposison, 25b.Place Of Disposion(Name Of Cemetery,Cremawry.Other Plata) 25c.Louden•City.Town,And State '. . - s 1,11\r p
®.BVial�:0-Creme- '0Datatonb Efvawmen t.r
❑Re-neat Rim State • . s `.
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QLVJmer(Spedy): FRANCISCO CEMETERY FRANCISCO. IN ec I`
2B:V.as Coroner Conaaed7 27. Name AM Complete Address Of Funeral Faaey - 27a. Rnerat orna License Number', }
COLVIN FUNERAL HOME INC.425 N MAIN ST., PRINCETON, IN 47670 FH8300567.1'9 t�.t4.tt D. .
270.Signauxe OI Indiana Funeral Service licensee: 27c. License Number(Of Licensee): ., Ci ` - e •:s'1
MARKR.`WALTER,BY:ELECTRONIC SIGNATURE FD01013010 - ' 4
1. tii; Cause Of Death (See Instructions And Examples) - ---••,Appro ima e3. 5!. 'II'
:t 28.Patti:Enter The Chain Of Events -Diseases,Injuries,Or Complications-That Directly Caused The Death.Do Not Enter Terminal Events _ r. (',) -Intervat•Onset 1 $,
Such As Cardiac Arrest Respiratory Arrest Or Ventricular Fibrillation Without Show41g The Etiology.Do Not Abbreviate.Enter Only One Cause On _ f .To Daathafx i}t -1
9.A Line.,Add Additional Leas I(Necessary. -
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:Immediate Cause(Final Disease Or Condition Resdteg In Death) A CARDIOPULMONARY ARREST •- '"HOURS--i•M4t^- ' j•.
°a um,a.ar..e-vop m s5.l:1yp l
Sequentially List Conditions, If Any.Lead'_ �To The Cause Listed On B. GASTRIC OUTLET OBSTRUCTION DAYS Sti/'('K�.....At
;LiseA•Enter.The Underlying Cause(DiseseOr Injury That Initiated """'°°" °9 • W, ;<''✓,.4 ii } er
`.The Events Resulting In Death)Last / C. • - .•L7t., .. k'r{' 1
t..ator..A 6e.e+.aq
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•Par,IL Enter Omni 5:csj,% n Coq' CanlbSic to DeY.n But Na Resdbng In The Underlying Cause Given In Pat I - 29.Nis M Autopsy PerteCna 7 t 0 Yes • la NO s 2`A 'gJ t1,T.' F•h�� - - 30. Were AtSooty Finding Avadase To Compete The Case OI Death?4z 0 Yea:0 No
HIATALHERNIA WITH INCARCERATED STOIMCH,SEVERE ARTHRITIS.SEVERE CONSTIPATION .
31..pd Tobacco Use Conridte To Death? i 32. If Female: 33. Marner Of Death: titLf?<-i,�s'sT -t:'
0 me Rene VCIi,n Y.e ,Q Rgea At Ica a Dune 0 Net a.7.a u e,.7euvup a tars a as 0 Natural Homicide 0'Accident,°;Pendng Inveslgao .v
❑Yes ❑Probebry0No'0 Un aoaIi Q wmrY a4R.oan don.m Ir t�s R.7a.vs.e m.e••Val 0 Suicide O Card Not Be Determined 1,k{ ` '." �. c
34.Dabs Of Inpey(Mon'NDay/Year) 35.Time Of lePey' PI on n, (aG me Home.Construction Site.R tauratt Wooded Area) , •37.Met At YAxk2 fl45C 1.•y:. J ... .' ❑Ye r ONO t l
38;Loration Of Injury•State 38a. City Or Tam 38b. Street&Number 38c,Apt.No. '38d. Zp Code .''t 1 - -
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PR g'4 2018 - ,:::
39 Desoto Han Injury Occurred 40. mTrge,.., De y . ...ay t; .._
Qaa.we..0 Ds.ry ...aye Dm.ler.drl .
41 Spit,,Of Person Ce2lyvq Cause Of DeaM: 42.Cert�`.n(Check Only Core) 711°,f�/'' `j
KRISTI K-PECK BY ELECTRONIC SIGNATURE ®CefliMgPMaldan ❑Gomnn ❑HetiOfSCer� i c ,
43 NameAddressAfwLpCodeOfPersonCeNyigCauseODean: GIBS° COUNTY AUDITOR 44 License>Numbef •45 Dab Cen:5edi ii I',
r e 1_}11"1 l a-..r / 11 i". f : .
KRISTI'K:'PECK t 520 MARY STREET, EVANSVILLE, IN 47710 0106603'8A- "•103/29/2018'9- .1!
,45.-Add.tonal Funeral Service Proiidal: 47. 'Aker: .
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48 Slpanra of Local Heat)Ottcer 49. For Registrar Only •Date Filed(MonlvDay(Year) �1 f,' '1•ROBERT KENNETH SPEAR.VIA ELECTRONIC SIGNATURE . MAR 29 2018 Iticy ° �at .•
• , 1 -re.. AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) "LM!r [1955'
st.4 ve • 11,•E•-•c:
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a6;i3:- 1 �-aoa- o&01990- o0s 9- v yL I
State Form 53395_.ATTENTION ESTATE:'The•Social Security a is being requested by this state agency in order to pursue responsibility. Disclosure is voluntary and there will be no Pena ry for re usaLIC.ti..t$1{V '
WARN 1 - ORIGINAL'DOCUMENT HAS A MULTICOLORED BACKGROUND ON SPECIAL WHITE SECURITY PAPER AND THE GREAT SEAL OF THE STATE OF INDIANA ON BACK THAT,@1,y
S 7i. TURNS-FROM ORANGE TO YELLOW WHEN RUBBED.ORIGINAL DOCUMENT.HAS'A HIDDEN VOID ON FRONT THAT APPEARS WHEN PHOTOCOPIED_8S1b.°$ .'!'&6668