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Death Certificate - Pauley, Hazel, I_8/1/2018 • "trt n _ `�• CtriN-5 ANAfSTATE=DEP TME_NTyO_Fy'�HEAL;TH , `;' gyp" * ;�tSr-'"'';''ll r f ti it i a DERtTII(FIDAT`EW)EATH '` r"- �i1i6, ilgr ' i1t 4` t --. 'i f t r4.4 --„ /t. `1. 0,Lo Z l P.i. 1 '2%e l ulg '4' Cf f�r N , , 3'jl �IS 025795z �) a Ctithal ND 000=117 _n`� EDR1Nut0000005t State No. ' ,� � 1 Decedenh�JNNama'l EE*MMimdie ll)V' --�y 'r tF ?.laWaaiden NNyes ffemaale) r'r, 1}(Tt) c2 sp.g%W'r3. T, Off ffl,4T 4 �mn(.1c vtarrcean(i sw-sd '41 •.t. `� v ;3 y-.A 11,141>!..Hi9W,..*".421 ikti. ✓ ttiG /.-11c�.:1 ty�r,.., i -��1 Ye.1" 'A.:�'ii. HA.ZEL:I PAULEY + >n c<i ' ▪ THOMPSON.r..A`svti:v w1 ilFEMALE. 33610 401PM air 0525/2016.�v to 0 p (WASHINGTON»TOWNSHIP IN - eEwfalUSArrneGFaees7 10 U OuT Gottaee V&A_lWSpitaL ake+E'' H�r.1-40a:IDria Occurred Sonratare O'Ya Ttun A Hosp‘ ,j jsr t 2 1�R '):� .0t:67;-,.... TF iJ : ti^ t y elf rtma.� �� Q oZer( Fje4171 ®DamCerRSHTer "-Nanny Xax }rem Cat Faa'y�`S_ E�`i ❑Yes ,- No ❑• c.r--n ❑IryeOent❑Est-ceCry Depadman Orymer2 ❑Dead on Armes +xr•,aa 3 f\�se_Eltu"':t'ir�v � Ate- -'a!',.t�,I s a t.A t..:- r- t �-c.s[,su w*ss src -W�awea 1�0"�a(�A�{tt'1 sv.F` - ..< dL��:.;i ��'S.i S t .r La My Fattty Name Of Na lnsttaat Grve steer and Nanber) RS Cr S'1C'?' , �.•rariy tc 4x'1 P I 1"°yf' t) F- 71f 4- rY f I 1510'BRENTW000 DRIVEC -'s. -.1.. _ _ _ ''�4Att-.44 .0.''.r ';�S.f lr�z4��,4:-..:-A1.--$.10:‘` et r. • 4 2�,)wa.-rs'rt.. .I >;.�.�- ,<. `'00) 12�QTewit saafnd ZPCO 0i xC.. ' N�� v �1F�1 R Of Desnv�,St: RX. �.:* „14J,M • ' Thai 't I r •} /t•. ;tom+ t .;.i ( s: ti. •4 ❑iManed ea,But Sepan'.ed B.p DrvaceC:NI M.-' PRINCETON-1N 47670 t • +: `.of itl-` L �s'4.m``ti- GIBSON Y3''�t,t,kr.n !. ',t• ;' g®;Waawed lO_Naver Mar iegilllS1n J1N1;y1, 15 StMwq Spousel Naas • t, t0� 15a Last Nens Belle Fast Marege` t1y�P3•.l8 Dea ails Usual OCapaictf R>:F 17 i4 Of BusaeasMMus'y,T ,i,, ' .d +'. ; s v `�%� t 3 r-,:-..t.--n s GOVERNMENTri ' 3'67• - r as4 k z> il .cn'12Y�^.a" �� CLERKa �.+S�r Ss. rn sa 18 Resideae sirs - } 9a'CoetyG,,r �,���'' 9�Il�f 15a Cary Or Tip« alt.si .jJ-J'.!'�..r +5ija�,-TA wic i }= i 1 1•,-'Li 1 r .x. c ; - ) .qfi tl4ry- 7LL .? •v f-r� rattftti ?,/19 '} .r >{�. s�4"--y41,fir' INDIANA ` A _ w asGIBSON.t-.Sa .-.fir-st.�1` PRINCETONN �' ,-*f SIC.4q�' `/ <•i.,-.'CF• �.y``Y:4h', .'1.J. ,c.-tz:I.•.^i, 9. S.'2et1Mdi, - _,,,,,,,,,k,,,4 ; ' C t t z a �ott i,/,.;+V+,t ,▪ Li,'", j +11..6 ,,;,,y-Si li rf'®:a1,i❑Ndr'5 111510BRENTWOOD.DRIVE ` , :yZt eef-gyt : .t • 'tt.'r''Y altel-AZ s.ril �i e'.P'` 1 9- + 47670 . 4Fa �R�r e 19 Daceders Edtces:at i - -.? •20.'Decedent Of ttspauc Onpin' its``' ' '21N DeWenfs RO,Air _ '� YS•t. ,-;`.-' -t �S .,.. r� HIGH:SCHOOL GRADUATE OR GED •, j°n2Gi y` _' - �` ''S `aSi+ y` 'y'"} ``› ~ '�Ac z g COMPEETED? +'..$.2:tx � NOTzHISPANIC^tt`SC.',S White'w t 1j e,I i"tt�v i ttlEt'k h"t i .24th .t, 1 �PercRs Name(zest M ddl l▪ast' f J3 • ^a -ae 7 l 123:Paaat le Name(First MJdd'e lase Y t - ' - I- 23a Patent's Last Y�Bake First Mamapel� a HERSCHEL I TH• OMPSON -i -s •<..�,•�, .? -.s..�tt`dti . sp ALDA•EiiTHOMP.SON S3L' '! a.a.._.s:11 FORD ti'3',�v,s▪ T/ i `��Y±� '`st, 24 trtbments Nam "'t-r'L 7 24 RitUdcosflip To Decedet1 p 24b.Mang Addreasd"(6tr.NNk Nanbr.Csty:Sieve/IF Cade)'%?s a �,.r '7trf# 1 :Vs t4 r s ?��7�. Y�t t-Y fa`t{gsvrsarwra?i4 igEst °' iS0iiverx �.,tts Ih s % t'»1 V LARRY:PAULEY �Y _y. SON'51. uE 'i 515 NORTH'HARTiSTREET'P_RINCETON�IN 47670rti ,.t1Lpt`.c w} s'4 e ..-2,21.--.." T v -.4 f-C"4- -TH2 t _ate'25.• a q Cara ircr`tittW:&tat'imt ,�'- ''s i °t33S•a. • :Thrti 32a`IO " �..'yt e 25a Me ti:a Of DSpcs are a • I Aria. r, U 25o El a Of Dispostton:(Nara Of Cemetery.Ctemaby OtwRaca)j+25c'LOtxan Gy-TOwtt'Arld Stab `-yr� t'1s �� of f-'C''Z.y r ®'Bts+s �Csenu•on ODavaon O Emomemta .` 1 edg 131 t ilir'q1-r e mi } WT' i t.F�;. .#fir+ i ii O.Ranwv ?sr Sate '4 /(' ',LS`.t-1.-- at t` r- �t'.y c+i�4<i+1 -f✓ �+ far-t) 7 44c-f. n i 0 lierS(soecy) ;:ei - r,x s..`t-•_. SHILOH.CEMETERY z::a `-r.�pF.4'���ti... HAZLETON IN i.�> s"k.�-�%mot . 12:-. �. .`�:s`''444c - `'t S a i 26:Was Carer Comaced? 27.-Name And Comer,Address C-FFuu-meal Facib D- f "" `�x�i9�,}0. - p� i `,1[ {t ( ^ l�a t9-1 r'r IY+ � y Horne��s' r;•7 re?..tAti yLT lYA•;."L ACri ' 19Ue' +ciF'S1!y.. } X.i y r<•_1,`�, i1 -hAW:0 y 237.:..�st ( f. pwee?®"£ - . i COLVIN FUNERAL�HOMEINC 425XMAINIST.t;'PRINCET0t0h 47670: t . 11t�* :tga {, F,H83005671 to 270.Sipnat.fe Of LMme arena Serita ticensee z 3-OtTAi Y' v�.�-, t 2lctUcense NtmM+(Of Ucensee `s+ 'Y �h. MARK'R1 WALTER;BY ELECTRONIC:SIGNATpURE it .;-; .. t�}� EDO1Oj L ,�1 s�:%+r'V' -> �} ♦r Ct r- `;•�-1 wP,'c �L. t ig wt sti�.t1'r ce-17-alLsctee(ruindio°°ov.5v Sarre RR"4 71 tp,F yt� ��3g'i•}AOP010mffie)y`ras id 28'Pan I.Enlen Tfe Chas+«Ewnth Diseases Irquries;Or Cooiptcatons=.T1fat DUeCy Caused The Death.'in Not Enter4Tennmal Elba .„, R I r 3l treat Orsell t s • Such As Carder Arrest Respratay NrestT'Dr Ventriaiar Fanigibn Wdhat Sihowtrg■The EUObgy D5 NOt Abbrartati Ertel OiJy One On ti. To Death`-- ALneTAddAdd:tonal Ibis CN '1 T2• i(`�•-tidy v vs„ yn�., s.,�.R `t4 s 'r.,-' 3 . f 1. 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T ti t�t�Y{�I•'. 1 pp t'` 130;Were Autopsy Fe rp Avaaade To Complete The Cause Of Dea1R �4 CHRONIC KIDNEV DISEASE GENERAL DEBRRATON. tA'� 4i`. e,4� ,.i 1 sb�as•, ��"'°-' r__^T-°">c f Yes W.f.. , t31 Did Tobacco Use Cartzbtte To Derlonv.s rt 321U!troika 2Q uati ' ,- 33.7Mamer Ot Dear.:7K er JG - > ti it'. ick .+ �G-.-- `sC i`'Y t , -�.`� � .**Ott Prwysti c"xUMC Om OO2Sa f- "LS'0.513 retie ees :4- 1 s ❑rurni.rtiet tr v ❑P.r.sune.adm ❑hot R.M UTrrnwtn<amaow -"ar re10,HOmiora" I]Pfl s-..SP1e1n)12?„�lgn�v_asr'rtpa3agsti 'ti `eats l]Po�y®'Na ,,Unk 1 SQ�rw?wort male*COsys TsIsea.ts. lC tore s Mir tP., i C'StJ de lO'Could Not Be Determined 4t).M.ae 3,J5a,..ar 1�f 34 Dab Of h*sy(MpradDay1Y.a) rt rimes 135>Trte Of lnty y 414:4---,...r-1 tae. 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C®Dertbti PI13d ndinl Coroner S...1 Her Ottcao tail i 1;44 b Nape;Adders And?Cob Of Pram Cerfyrp Cause Of Dean s , ';•Vf.. - ♦ .?r".tt_.tith_1,` , He y'°,Nus�.ti` i Z.CertMet -'^a. ~a l .1S, f\F I1L X AZIZULLAH MEHRZAD-'X98 1ST�E�EVANSVILL'E,bIN 477.10 ".�' -.C.-. .• x4t _ �+ et � 01057692A l< 7a1•X;dh 06/0212016 441 � et-: A7 Alus:r rc . fi' 9 ' 46 Aad Vre.- b V. PTV-der--l-r-0 uecar r- 1 ?�∎Wet,,'Yy�,,Y�' �a' P6- r�' 4 £ ,d; 7}a. !.:..31 t rt 4.5.,:e: '�tl, '" C; %sue., mar °. .a r _ i �X b ses_2dM HtaTaear :.sji '- tft."N`tw4"dc'�`- ; "l> 'i' : Al2L•'+ -..a4 ,?,RSasyar.Gyt'y,d -Q", ,---. t""��,3 1T 1*.,- BRUCE BRINK JR VIA ELECTRONIC SIGNATUREc>..tf'3 1 L"* � `Y" '• .- ? i�r r.f� d JUN 02 2016r 7a:Tom„ k3o„r ]]III Sr } i -'. -' .e•4irt 4��:`.' Et' R't' ✓_r AMENDMENT3TOCERTRCATE OF OFATH(ENTRYOR ORIGINAL)iky KI ,t n4 t".Et✓">3. Sl • '7IP :S @`r• s q21 . _ "S. .- a_�2 4 t.-, ���•"/k .wt,a7�.� tx°^C' -. +� - e } 4'.', ., tx'r.,','(v7 wro :g -.s rs: ^i ©I •�m {�` .t Y KJ 0- 1.0 t . .-1 is is 1 - �lt'li ?'t`i,.1 t.• --.. .. t: \/V, ♦ . `a.-S1 A 4 �3iv:. :�-Ctig-2- ,.- wV v- .a?.'Vl f.+ � !'r.^.. �9 Sara Fam 53395 ATTENTION ESTATE::The Satvl Seamdy A a bang reciuestao CY`021,-ta'e apercy n ceder 1d puma reapmsb6�Y sD sdosure q whah:ary and N°re svq be 7 panat'Y-re4aa-mici"�Z j�t� ., . A -a.. .r'...., HAS A MULTICOLOR-a)TKOr- BACKGROUND ON SPECLA.IWHITE''Sffi6 ^CPPER A DTHE GREAT,SEL OLmE ST 'O INDWA N BACK TATe','. 'zi ^WARN ING•-TURNS FROM ORANGE-TO YELLW WHEN RUBBED:BBE :ORIGIDODOCUMNT.HSA HIDDEN VOID ONFRONHEGREATSEA_OFTH HOTEOFtNDUWAON Bsate- Ai e a . TURNS FROM OPA.NGE.TO YELLGIY.WHENRUBBED ORIGWALPDOCUMENi.HA$A-HIDOEN.VOIO ON FFIONT,THAT APPEPASsNs.EN PHOTOCOPIED�ar1C$'3°�.�rd•=F1I''�+'i