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Death Certificate - Schoultz, Charles_6/20/2018 IL�crri;R f1 n��fvtrrCAar:_ .n%l^� CERTIFICATE OF DEATH S.Lrr�;•.t A",-_i�2a`_'�.v i5 C.4 w-- .....% 1 ' t`4: IND ANA STATED PART E T OF�HEALTH a t ^ ��� �•<T i,`< a" .1 �.. . 424 1 y0C1.,�al a•;s� CERTtiell ll�ill k . ! ! i �..,q.v. `'�T� L> �! . , tocal'No1000041 ` EDR:No 00000064.8662-;`•Ss 029.006S`' \ \ .. State,No. r >, ��'•1 M.<eenrs Legal N U�Lest;MiddksL'ast)v ; tr' -r laiAladen Naletlllfemak)r v� ,rtrsea Q tt,3srdrw Denis uDa:e Ot peah(MOKNDayYear) ya%411.6e%GI lily -,1 /alt- 1 �j V/ Ili /•4 IN %' flN �M rf in tear) ii CHARLES?E�SHOULTZa,, i 1 C.,1/4 l- - _ ',�'c�rCl11.� a t d2 E LE: ill ���q�r .1G02 40 P,M �O6/09Y20[`111,^8 �`` •S\.�S�O/a�a�l{ 'lO9I Deem Omned In A H peal r yy a lOa.I10eat Occurted Some.Nere Cew Than A Hwpital t vn � ! �' �� hFOHO.erA �.t��v,� �nJea �i ' i��� �4 1+ idly ❑DerndeN's Home N ®•Yes ❑S° '' vp ®- utsvq Haerdaptertn Care F ❑Car.. n niter <n'Oltrrency D,111.1emr-csaa ❑,Deaden Amyl ❑ �svDt.d.?7 ' - ,, 1.- `nr '�a. 1 r km c1!�s��Loua�.cl�,dara��.,ear�.v��w .xv.�:,- _n_��,.�.�...�.� € � � _.�:tT ('f I ila tFaalyN Of,Neel sob^pn)Geee Street and NUmSerie qe +1'Ff' �{ft;y�!{p� i fie.FL / yr. � ' KEWOOD!PSSISTEDVIVING .tte° a!� llfk7i �l�tdl!'/�`.�C�lp��nrali 'fl,!( % 1p� %wi'Wlf�'�Ji�iEI �y PIc 1 f,rt2nCiry Or Town:Stab.And Le Code ` `N. :r' r 'V - _` •13SCanty or Dean, �i • T1 et410eaal SalusAt Tone Of Dear 1 _ P- 1�/' ra 7 R' , ./ 1 n1 r. 1,4 rx# 1 b®Mated O Namedatac-e wed ❑avorcedt �a PETERSBURG 'IN,47567,A1� !/�1= ;� /°: R K� p` 1%.0" S 11 yO Y,+d talStarert Mamed ❑u;, h5151, 3 t . ( PIKE %�k(r � d� KA,Of ti� '.AO.�"� Si-f 1a7,9„ies"wre \4 i t/:A • \ ..tsa ld4 B Bee Feat aena9 '.(r: Ce ll6VDe Vrs Usual Occupab \ul✓�4i�S�t]17i \� �f�> -.a•� >� A a Sr. N S tier COMMMERCIALI ,. p EMMA LOU,SHOUL`-TZ G t1 ra (i , - - 4ltr . t. OMERE`Re 1:- sA,t Tam'?'' .t,RETIRED SRUCK,DRIVER-fa ITR�U'CKWG�COMP.ANY l yf y t=:p'Resderm-5txe ttsa.Cwmy , U �tee7CM OrTanr ■s ll i s•ft 31NDIANA�`�_e°` i ' P-IKEs, •:L \\� P.ETERSeBURG =dpi\} .:ii. t.-.t.`../.\�e� � 6 r 16O9StreetAMNumter , 'I? -..- 1 T 1 /I •y, • 'led PC No." lee'LPCaael Slwnsk GH Lm¢s ' ilU �� � pM1 -+ r ���' . , �` Ic�r tA�t�)I •�� t /" '10"1- i i KEWQQD DR 'Y:7r�lis. t,4' i �y� ��y�/' ,1 l{'' �!`` t� I Sit��1`t'f/ "S ' : ®vo� �> t a.y.� i,.eS 1 L= ��� (� �••n v.�'Cec i-.� 1 v 47.67 a 3 a•. G :t ILf,E ____ r FmraT:+�L,y�� zo.Decedenta,wwa:c(27.1 �a 21 Decedents Race n, :e, -v HIGHISCHOOL=;GRADUATEE9RJGED "W 11 ~ �,!.d "10j Ft� 1 `°i... 1`.. trir�> ne �r p„COMPLETED TPSin11Ut fnlQd N SPANICI ,:::4,15/ IN. s1[Whit .!t o-?ti4 n/tt{!14s/ ' iE .tr�"1 r f fit I Ws 22 41.a re Nene(Fwat'Ntldlenasi) 11 "a✓ t - - r tI 23'ParenreN (Frst!Mddle La t 4 1fl A r23aPareat's Last h Before FrstMamage ?EC t . ..,,.1N� ral 1 4 S. - _ .a�$1 [�I� a I f s, " 4e ••• ! v,%. /� � �a .T„- l -p CHARLES SHOULT•Z�. •► _,c z'� �„G� t�. ., MAMIE SHOULTZ Ps v�aL��,a� WILL•IS�rs4.3-�- i ,w�..��st s i�`24'In`onnamsh me' I ' e 24a1Relaaonstep To Decadent Reel MsaogA0�ss.(Sveet AMjwmeer Gry Su•e Zip COde 11 �'�t .- u) - , 1 - •I aI © I0' s oi,,,�.- ,..i y__s e„Warn, _ JAYgSHOULTZ-. i -.r4t,.x SON t ®5825fE 1,15:SOUTHIRRANCISCO,IN47649� +"-:. -4! w,aa'@-,.is( 3RaLtSar ���7�RosrtL• `Li'`F i�N. "lli.1Ga ,R"lV':zss:.`�-' . . e,.� -�_ "`- "118.a�z���tl.A'� 1C` R 25ayienvtrdOfEapp!Lan 4, G"�QH"25er pareO,Di sposinpnj(NaReOfCemetery.'Cremato ...0. PIace). s25CLaacO C.'TeefAedSiteuq t-'- - a 9•W �.olieeni®•S uIX1 I]IDO\c._ „a,tw, r l... , �, I� it � ✓ i+1 G 4 2:4�1 i '�1�' ��f 4��I II - ` I]�emOVaIF• Stab �� Y 4 'tom ` l �'�l a 1 a ti.} I ���J O .0,dme( ��±�. \ EVANSVIL'LE.CREMATORY. .1-L\� -.: EVANSVIIII EMN • eA':1-4.<", --t�'..••21%.. \ a '1 1.7�26'N Cecilia • \, '21:1Name And Cmplete'Address Of F nerd atary t 'I••���G 227:r.FF Horne Isensse N�• W I liu V LAMB BBAASHAM�E ORIAL CHHA EL B ErWASHINGTON STR OAK�LAND'CI�si,�t1 i 1'�'% ' W I ,attnco .,it IN 47660 � 111% 11r!".E bt %ch'`,41�F� l�.`L 1)l .cL t F.H83005312�1�. 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DoT Of Injury(MOnYVDa_y(Yealll 35.Tare Of lnjtay. ✓ R Si X36 Place Ol lre59•Deredent'zre!Cpnsuurmn Ste Restava 4podr.V Atea) 3l 4pryN Wcor G{�����y,/�� ) 4\y \ ,e6 t. a 4�rf(.❑�i (`T Y ���1'Jl1 A`1 _ l 4 .'c d _.O�• !S /'"` ti `�L`\ �. \li d'- ��`r�Sods t V��\ ��383j�aatra��nppO(rft�i�jj��$nbnn ,{ irate g 38'x•C. 0cTwm \ is I 3 j)S/�ea�BgNUnEa P Y i38}c Apt'NO% aecnpCOde r, I < 1 11191� f IS?falatr sulut Iil�l�lilUl i11v '�'RI=V-1) 1' 'i�tl E�s1Y 111✓/2 1 L t'39epesmpe_HP.v ICW"cmte -er,K, J, :4o trTnnroaw.minitn• 1 n .IIT. J,Tt,'Y I 1 n '",!JA ��', \.'�I\�t%�!'IC.'�i0 Ip\mot rti L1i\y 1[lD��✓��OFI ✓ L d1ILDli_It OsOs i.41T5wata s0 Pers.C,SSMIyCeusegDams@ LIEW,e WIe 'SfTif%����,'Irgt,C`❑ at p ,t uptl az Eeiun /Curt irn6OnellF(�1� ` �ptlli rb I DAVID�CHULTTZSII%BY'IELECTRONICISIGNATAU RE�"NBItLOC�6W11Ci➢�/��5f1 ,',. �'GflJW r®Cerdr?eic Piy,6antkn Cormec ptear�a5Qrl4 I «•U Nave Ade�s'Md Zq Cade Ot Person Cenlyuq'Causeq Dee: . ,`k6p65L4,, NUmMrr1�I^ C GS{tL,�S1."0,..TaPCeM1fied s C e s G1 1 -`-'1't \te P\\/ tr e nh��,Q ``\\L�II 1tluLr DAVIDSCHUL-TZUIY, 1231•WASHINGTON,SQUARE, EVANSVILL'E, INt_47•7,15 ItP� SCI ' 01050928ALb 06L1t1)20,18c. � 4o)AdddvW Filerel Srnve t \-/ 4] Aids:"' `°r` :2'-' #ive of Loral each Mar. V.. �'�.� �� ,49.Fa.Regist Only:-Dab <ed•(MavT/Dayfle A Ft NATHANIALPDOUGLASVGROWW LECTRO IN C SIGNATURE r�� �,.(�.14- tiiy ,� ��r20 �-•I cC `1� .. - a-•az In 'may itit WK...., 1.gsz&ri dU �uNJUNS12r20.18 �5. r•1 '''1Ztlunr,ainu0111 Att's1 �i' miurs tilts tAENDMEN-L-losR inic o_EPATtimiaJORORIGINA mtiuSGvat9imti f naRt)7L/JtR1 IW2 ..-Ala]G a 1 L d .� - � .0 - a s 1 ' Oi 1� II iI li ,....../ � O � I ,IC, �� �4 . ai l tt -1 ., , r%. c. y - tate'Fain 53395 ATTENTION ESTA)*.'.The Sa titSmrtrty#;flies- s Deng reques et Dy this state egen art Thter to pwsue responstifity�Otscbstire ii vnhslay ant there wiB b'e no peurMa tytwre`usaL_ IL tittWatit',� ariutk.a-.atuut _✓�ium :�v moiNg muararlauuirs eultu �tutita titttxi utnn-crnitir. � 1 WARNING.aTURNS FROIAGMRENEeFOWUOWC01. ORBUBB&ORIGNWA1 DOCIAENT ILLS A HIODEN.V(NDS'ON FRONT.TNATAPP.EMS WHEN:PHOTE D OCOP J � THAT 7lo. ►3- is. -300 crto &S9 04341 .(94- 0 -1 R- ►cr co I . 5 c?4 Do y a lo- 13 -I $ - 3OQca13 043 cos .3) t, ► 3 - 13 -3/3cm o° `Ni FILED JUN 2 0 2018 GIBSON COUNTY AUDITOR