No preview available
Death Certificate - Sharp Sr, Jerry, F_7/16/2018 - . .•4-0-fri:;..L'-':-..• • .;•;,---I;••••,;.;"''' -:= l'hf■IDIAikikr.STAte.b8',ARTMENTIOEMEALITHi:?”frPP-lirirc*: !r;':•;:41,ii-i.,*...ii;;;,:iiirz;;;---- -..c , \ i.. 1 ,: ,L ,: , 1 .; ,..., .,,,:„:,,,-___,:,,,...-. .--4.,,,,,---,,,I,...,,.„,„ ,-.- ,.:-,,,Aliic?-7-;:!;;;',:t.,--;`.))):-;?;i Of .;?5--)t , ;. '3- i .5-;:' ::..."-ti ..2-', t 1 .it,:, -;-7-r, ,1,1:1-P el3,TSIgietykTP-° -lPPC1/4T117t1.:.: t ''Sr"' 11..=":41.-:-'.=-7. --.7'''.Tf ; ,7 k-, -- f 7- - 7; "ill -;-)Cc7, 't".;:::11:`;;-: ' : :. %'. li"---:•:: 2.)))).,h'':.-illnl:. - -: ; • ). ::„..'.:.''..)4-jie":'"-L cic 6 I N6:000238. - i 6. 000000575271-- .- s-. !z. Lstat4:No021'956.1- . --:: ,..,,, ItDe=dents Legal.NamelFirst:Middle)tastyr .,, '-',. :-)k),;;;; . ;)2;.,-ta.Maidename 1111e-male)",;,i.--- ,• •ty• 2:-Ber:-.."--)--)3:.ffincie91,Dea!s);k:.i.,- 14.)Pa-C't Dec.')B.),"'"119514-:fnf: JERRY FRANKLIN%SHARP SR=. `..7 . :;-. . .).., .1 -.:-5;-. "-'); -....:),..7„. '.--;.:55.';').: .. MALE \2,...il.2:4e;PM- "";?";.›64/ 7/2017.:S.:-7,`:-.- ) i ,' 76 --;,..„,m4fine: .:v5 fl DaYs',...),/ :r.5-1 H9tirr,:)-;:.•:...-).1.1,!;Bulest.',.-,;‘.417:‘,,-.)--'04/22/1941?;.::::::--... ‘SVVITZ:CITY,-"IN:".::::::=1, 1 ""--" '"' --;-"---%. -.--;'''" '-'-"''• :::;"'""=":„ ,-;,--,--',PP": , .." :..1'; 0 Hospice Pacaty ...10 iSecthes;ei4....;;cri.Anitic How;A:;.,-,fn• ei-.F;;;Iii,,; it..Facility Name (If Not Insttutic9.Give Stied and Number) ), c) .. -) (- t s; , s ; t , , ' •- t . : ., :, ' ) , i • '... ) 1 DEACONESS GATEWAY -;-; % " ' i;-- : 1 " .= .: ' % . 1- ;", % t-- ‘ % " %; . r ' 5 I .. , , . . ....- b'fiarried 0 ithried,But ioatated 1:J ONOrc-e" .....,... . , ••• -,., .• ,, - NEWBURGH IN 47630,-- ' -.. : C / • ,- 77rt ( T-7-7 ,tl- 7:-..). - -,;77 WARRIdle1777::. 7.`rrir...7. 7),7.7 2.c1,,Vakdwed, 7:::qHeir;-1,-777T,ITyi.:. j:: , ...- -. I5a.last Name Befwe First Marriage .;r- ,--)) ; 16.)Decedenrs Usual Occuppon .5- ' r ,t17.-19n0St BusleessA„?dostry....S...,-; '5 ". t i; • ‘ . ': ' : I ' - : l 3' . l -) ; . c; :=.„ t ' •::: 5 e -1 5 f--. •.r. i'); 5 . % DUKE ENERGY PUBLIC - • DONNA SUE SHARP , . ; . , - - HILDIBRAND :.. ; -:. , . UTILITY SERVICE; tr: t":" ." .,:". UTILITY 113. Residence.State . . ' . - -., )184. Street And Number' laa.'Aot No: ". '.18e. Tic Code- -) -BB. Inside City Uri's? • • . , , ). , --). .) k l .,":;• i'. :, % ....: '; C '. ,.: :., :.': : t., _ : t, . . : .. .• • . - • - 9.0.6 E...ASt KENTUCKY STREET &- .•': 47- 6,7.0 0 ye s i C No• 'l:': i 22.Parents Name(First.lAddle.Last) , , , ,... .,,,...i• .• ' . ) ) ,; •/1 -- ,,. -2 3.Parents Nam e(First.M rd dle.Last) ); ,r-- s...:. ," .; 2.3a.PaParents:c.s Las t N:.am Befor e FislMar'1 a,; .v 4 ; " : - - ' : . s , Z , ' - . Vr : e; : .. 1 ; . - - N FRANK EUGENE SHARP % MARGARET JEAN SHARP POLSON f' 7; . 24.Informants Nara. -- - - --- - - -- 24a.Rela5orsNo To Decedent),. • 245.MaSro Adress)(Steet Ad Hurter. State:77 Code) . - - ' t ' DONNA SUE SHARP , .:.- ' ... : I: - WIFE' --.. tf': "-:, 905'EAST:KENTOCKY STREET:PRINCETONIINt47670. ::-. v 25a)Method Of Disposition . ,k ) ; )t 255.Place Of Dspeslaco(Name Of Cemetery,Crematory.Other Place)- 25c.Location.City,Town.And State 5-. t-:, :i t •) : -.-;:.;;;;;.")C 0 Burial 0 Cranston 0 Do-ratan b En:r.brneht • - . l. : •;-).• ; -) -) . ; :-:. .;. I 'T. ., .:. )1°1' 3 : •., ' .1.: 1 1 :Ell Ocher(S;eCif)t...,,,• ,,,. ... %7,-.., • SWITZ CITY CEMETERY %-,,..„:" - . : SWITZ CITY IN:..::.:%. -...;-:: , ' •‘";--..":::, ,r.--;..:.:-.":::::::":‘:?. EI'fel:E)No . COLVIN.FUNERAL HOME INC, 425 N MAIN ST.,:PRINCEI-ON,-IN 47670 : • .-. .'.:, ! % : F.H83005671 : i..!:-,1',',I 275. Signature Of Indiana Funeral Service Licensee: . t -• • -, ) J• , - , , -,..- .• . k c : r -) . : ) 27c. License Number(Of license4). - ,) -_•r5 MARK R.WALTER, BY ELECTRONIC SIGNATURE = ;" .-- ""--%:"' / . "" ' ,. t-,--- .: , FD01013010 %. '• t.' ', ..," : " 7 : 28.Pail I.Enter The laatQ.c' vadts .. Diseases.injuries(Or Complications-That Direetikauled The Death.Lk;Not Enter Ter5thal Events," , ' : `.. . ' "t, l Interval:Onset'. l : Such As Cardiac An-est.Respiratory Arrest.Or Vent:tiler Fibrilla:it.,Without Snowing The Etiology:Do Not Abbreviate.Enter Only One Cause On ".. .',-, i ; 3 .. .7 1, To Death:. ) :A Line7Add Addilithal tunes If Necessary... ' •• '‘' ( : ' ' .: '. t l ,- . - l, ,), ); - , 7._ :', 1 `.. i t, , . E I k. ; ,:) I ; ,r l.‘-. Immediate Cause(Final Disease Ortondition Routing In Death)' .A.. CONGESTIVE HEART'FAILURE 4 % '.) ' .).. ) f .).• ) :-. 7:1 ..i• , YEARSt-:),. . 'Se5uernally Us)Ca:dilons:If Any Leading To Tbe Cause Listed On • B. SUPERIOR MESENTERIC ARTERY EMBOLISM WITH SMALL BOWEL ISCHEMIA,, . ..„• 4 DAYS -..---„,--• Line A.)EdterThe Underlying Cause(Disease Or Iniirry That Initiated • ' -.," ..), `‘,. .), .) - i ; ,,, : ) •.: cc__ . • ;DJ .5. : ; : s 2' L 7. t ; , ..) i 4; ,5 ; „:) : ) , ;,) ;#) . •• ;) 1)! .. )7,:,7 . - pan II.Enter°tee:Pore:art Conddions Contklau5lc to Death But Not Resulting In The Underlying Cause Given In Part I ). -29.wasAn Autopsy t 35. Ora Tobacco Use Conr.bute To Death? ) ',. 32.,If Female)- - -- --- i , ) s 5 ?..) k ) ),.. „,) ', i ), ) ) 33.Manner0(Cleath:)))),,-;...); •r: :::i;:,;:y-LT;::-..f....-. ::: b •res. 6 Prot.,*Quo diM. 7 Eirt-rtH."'•-•:P-7...714.77c4°'-7,0--.±."+kil•;"r7f''‘''1267i'°! ..th .0 Natial.)0 HtjE'd,:ig `4;7' 0 PnInestgtot , „.. , . :... .., r 2 ID ta...p....:.a......--.E,...7.,,......:.c..;.- .,0 t.7..-4,..M.,...nvfa.n...a..i....?,:- . .4 )0 Sac:de 0 erxrld NM Bibeterr5ined ,7„..";:.-:•'77::.;71:"?'-tk't 34.Date Of InPry(MondvDayrYear)_ ---•' • 35.line Of Injury•-•--, , t -:; 36.•Place Of Injury(B C.. HOM,Cceso-uctlon sce:Reszuraydooded Area), .37.Injury AI Wwlr7 - ,...• . -.. -38.Loca5 0n Of Injury)Sta.te .c ,. . 38a Ory Or Town -- ) ' - -380..Sreet 5 Numbe .„ :. ., • . . . . k 39:Describe How Injury Occurred• . .. , ,. . , 40 If Transcortation LnIurY. e. Cirf.'' '' , .,i• - - - --- . .- . ' . ne"C.rk" EIP -'w:UP'"a °C.,/13"`..1 ....>"-.?:. f - ,41. Signatge.Of Person Candying Cause Of Death:- l - 5 ' . -- , :: ...•• ).. -, - , ,-'' 42.Catyeir(CheckOnlyOne:) l'.ilt:if . .. t) C • ANTHONYDXAISER:,r BY EEECTRCNIC SIGNAtIRE = ,, .,: - , 0 cetrffg phyican. 0 earanit0..: :0 Han Offidel:tSS • r, 43.Narne.,Address A:4 aPCcde CIPerssr.Cerzyng Cause gf.Dep: ; - - ! 1 !„.'.....: -, : , . - , r ;44.liCertSe Nurnber ..f 45.:Date Certpeci.t.t.:31; . l' rt; - ' 1. - . )1-. ; il - -. .); .. ,.1. . i ) ,-tl:,,).:41 ANTHONY D.,KAISER.',;5j0,MARY STREET,SUITE•520;_EVANSVILLE:IN 47710; ..•,• ."----# .,;-.:;. ••••:..-- 01067215Ki. ..-Y . -‘2. --7:-.05/01/2017 , 48 Signature clLccalHea.",Office'- 7 ; .- ).- r," -, r -) 5? . ., --,-,,)-- 1, i d ..-: ' 49; For Registrar Only- Date art(Mont1Day7ear55 7 ; ; "... ftIdKY.E3 tEAGER;tviA.ELECTRONIt:SIGNATURE,..,,c:::-.c ..::,..:t. . ,i..,:,..c„,:.: ,E.•,,,,'. e,:i.:-..,::.7c,...c.4 - ;-A ; '. 2))..2-..(.;MAY.02'2017' -:.i: : ::•,ir.(.--el: ... -, ;- 5.,,--:_. ;,..; i.il ,-::::;.: -7 -7:.-:; 7? . .. .:.,•77:.-c.A AMENDMENT,Tg CERTIFICATE Of.DEATH pinay,OR ORIGINAL)t..2.:),.. T.-.S 4,r,.:.73..:i: .::: -... .5.- • ..7.‘.. .,- .; . , : - y"//::-::-"yr:::- 17 .i'M ; ';?.:::;r‘z :::::;:) .:::::::::::: :';',.... .i:k.:,;::V •_ , :,....: ... ..,,,,. .4 ...„,..,....„ ,„.:,,,..f.:!:.......44,tc.,....;..4.,,,,c.c....„.0.........„„:44?),:....4_g_ •"-'1, i ;, - 1:.'i, . '?. l-l'i 1.:::).:1,3 ," '.:...7') •--- =-;„.'•));•,j1;%.:);*:;.i4") ;: 4:11::-..i:CiffS"Si,:lit.-:$?-1.€ 1);,'.'.4)i-k:=77)-1"Itili-71-11 );',. );!;r;,-1.3k.5it-y;:,,,,`>.\tikk;7-5;_tftl'i. .-t(:;5-,';:t4r5(lZ)..?..1i). .3 '5'Stele Form 53395 •ArrENTON ESTATE'Tie'Sodal SeCi;rigt,is.bisicd iic;46i!eii b9 idi ititi gi23::oi-efit;lif Nis'0::9•wci4!6Thri;;Dial4.41?""Js:v"P+ ,64,4"i!*1-t;=.:e.i.40.th.N-pi-, ailr i piy.f if v,iiw. .-z:s.t.WARNING::::';,' rocsu RriifGmtrArt DOCUMENT HAS A MUtl1COLORED SACKG'F.tollkrON ECIA/:VVHITE SECURITYPAPER-AND THE GREAT SEAL Of.,THE STATEQE.INDIANA ON BAC THA.,.._IrsS nos PJAC.Tr5451 t tkw Wi4PN-n111:taPrlia`iRti:Julafflif.1111.,(PKIi la4i411111P7A.TIIIIriv dRikardif-th.APPFARAWHPfi,PS-1111-(letiolPII:kir itk;55:0)Thd FILED JUL 16 2018 NOheAllr - • GIBSON COUNTY AUDITOR