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Death Certificate_Kolb (k�yt. re�/s raiTa•nfi`?� -r�-�l�s�r��i. .i'. � CERTIFICATE OF DEATH a.,,I.ate �luitr^� �f��__.-�'ti(r�, , -- �,' ,�`j '- 4/4"/.4--, a�{{•+� GIBSON 1i©U�NTg1UDE'P RJM+EHNT ®,.pH. EAI:TN. �\ 17. + ` " \ 8.00 St.iPrince St � �� �` 1- ,.r ° � �' ✓� , e�� � \� Pramceton Indiana 476,7,0 'r. / P IlI� . ',N1' ! ,t Il /: P81i22 8 t�38g l 1 �d • ' I �'� . ( / re �I � � ,.-��� , �� Y ,� � %, ��1 /11 ������I°� 11 z " ' 1111 - l� 1 \ \\ r ` l� S e w /�� `" �F ��, . 4 °,*.n `'3-li R+EGORID 'CIDDEATH2! t �,IkI ,, { i `/ ,u•- ,•. , .ter ;( fsy'Y - fit,, II.,i% , i4� lSnR,! , r/" ;.344;; r S+ F. »tr.. . L !�, \\\ "`�`-L` i1�t4.. . h -e„:a• '� r / 1 �\�1`. `�\�3 s�� t%-"'")). �O✓ �v-" i Y b' \\ 1 �THIS��:.aTOO CERTIFY \Y -N '%. a \\ `. \ t\'►\� \\ r i \ .`a a I �.-� , j r v ..rP_ _ a 5 Y,• ©thatraccording; to sthe: records of»the Gibson' County Department�of Sta:-. , 'f� p,, ' Sc:I t•1.1 1 tf l 2 : . t, �t1 1[1✓ - i + ` t\.y,l X11 � 1 ._ c» � -[1�� 1 � � l yr � � a. \\ a ,B,L'LY�,, (. r i iii / �� / ��� / ���� �� 1� 1'•'Died onN10` 07- :2002 5 15 PM %/�� , J .�, ��\ Gibson General .:,.. al \ \ r �. -� \ \ si I .. (` � ', . ` \\A 1808iS" Kerman Dr zt . . \�,1mvex , / \\\ �f I 1}1 f(1�'k i Y :1 PuiFnceton LIN-P4:7670',41 �Il�' �//}]� �tt1�a���11/i\ p• °j 1 p*; age aE�death ? 7r7 Year-s y./ Sex:, M��'�/ / \a� \ \ T t `c,li� Wa-111 ,a : , rant �,3' ATI II\cli� .I ettll %�li�l r (� MaritaliStatus. • ` Mar ed , olor: White \' , `\�E \4/ ` �'�. � ,,li 1'J_{}�{{(�jCause,�of death 3 Card-xac Dysrhythmiat('4rweeksr)1 Left ven ricular r/+1\/ �i�Z/ 21 �}I '' I) {+` ` G_7f�1111t�Ui ��;� +E� -!'�tll�1[ YGIF`1 rl�:J l+RCG<<U. b i ,r�r j ,$ /p.� III �ty4 ,aYS) 1� ,�i,. ( /te a DYE veil (lu0 y��vp •"N �%F�c*,l�vn oti`�e�r�,t-aD sease,4 wont•-•••-:,,,,-"ir' ,`' �� Q ,{ , '.�� ,a'. , � (1S�years)r T_.ype 2 Diabetes MgitW s (1,5�years) '�'`W °I{,1.1 F 1 �� ., ' /Hy`perk�al"�`9em'ia e`nal ansa-tadlen rd1i► , `YZ'j�: