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Death Certificate_Harvey ,=:-_�>w>s.,-- .-, vr.:n.;afr,-- ae.e-:-2' • - • .ifi @Q _:.i '.a' ri-.._, lye „_p-�,`r'aya: ,_.: 7 1{t14,> p � I INDIANA STATE'DEPARTMD:17/9FHEALTH co , Pp q�(ai ° � tt• , I1 ��CER�l`c��L+ (tat�H� I� G 0 tt? 1'� t[✓iL,1 d,_LDDaI Ne 00.0.606 nA ..EDRtNo:0000006656.1=1 .. state,NotO_46.428 ' ..,.1 ) 5LDecedenl legal Name(Fast Mdd!e;La t)% v/ 11 I N IaeMaken Name"(Itfemale) 2.SexD 3�.Tmea Dean" < Date Ol Dea'Jr'MOn'JVDa!Year)" tau ;S HARt . -541h 1� u � �� t N,' t1g111f� 1 ��j�1nuw� Y U 1 60661E SHARVEYc� ''� l_� mMALE yt 07:08-AMA., �`rFoceignC018)' f�`;: IMa! d.�AhoI•;�n,Itnib0 "_ �lu 'lDa II �ui 07/14/1 31c Iosptt :GIBBON COUNTY;IN.c.- 1U 4,4. the tisz �UU y9��:Eiv���L,Lii,S�4 902:sttl)..kt9:e:eag�'vrreC In A!\1plil lj \\\\ 1Ut[f/'N'1_0.aV ll Dea,Occum9 Somewhere ONer.TN A Hospita ' H 1 l- %' !"'-."... 5� �iY U \\1�t7 iiik\.. �- 1' ".v.'V laHospice F attY�s0 DecedentsH e-SNmia,g"�Mom"M 1 •Care Fiat/ r '®Yes No UnWwwn i®ilnpaers E eigencyDepamne tOugxv e4 o Deaf Amval it es. 7I1�\ I'^ 1'r{'; l 1�, �� ��nul,.f +s+.nira-cis 3ararci�ttDl.,�s��am-ivis�InLt.vr_m d �pnL ' � lltllft' 11111�C�U',S'n rn hkl�''��II`IM�///�.,,1,V,1�IlJt' y//tit t'IFOittY.Name 1(I1 Notl sdhaottGne Sheet eMN Eery% t1 1 I)/ ll .g' }itA )( i f / { ry ryt{n1 I1 �'1' 4 .1 DEACONESS:GATEWAYAIrr t i7 ;!ill 11112� "i[1U1// 1 .'u` �1114L1,t `,s1131�/�1t1�� v lV�C/1�/y\•ll!N_ 1 iL\ 1�2�,Gry OrTonn;Sta:e`And Zrp Coe � ,/4t �v- `v - ,13 County a Deena \ to MaiW Stave At Tme Ol DeaT +r•.' aNEWB `flan /� rIty ✓ 4 'I{ 1�r Cl!//Citig.�y,,�/ `vv l ®MameaQ 11.Be Separated JI,Dmmced� ni v. N EWBU , ;:IN 47630 5l 4\11 Il�. ��'13I It ��� ,1dtP//l 'y WARRICK�IU/�'�illl� �;!I,ILtIG`��t^nap rea O1Ne.�lAamea 1O wwaloY t l 15"Suvm4g Spouse's N • �1 (1 LI 15 Last Name Be:ae First Manage G,16,Decedenms U ua)Occvpaoon 1' 17 Ira,,LY Duva>,sAr us J E',f � 1' S a�." :Jji �, GODING REWIND r� dam yAjlll t RING i PATRICIAiHARVEYO UI 1. IL. III:1na2 WALKERlltlll�nl/.lZJln(1n /J I� OPERATORY//t',i +� t�ll ]U, �e t/ _ MANUFACTURING !tR b . 18."ResMe Save (r er( !'County v- - b' a:air Or Town�1�s 1 r` INDIANAs .•. GIBBON.,,, -.��,rta\\ P,RINCETON\ M \t%i..t ,,.\ r tec:Y5o tAnl Numbed, 1 l t v� - v !c U ri xrlBe rAPLNo:� 19e^Zip Cede dal. nsge Gty Liman? � t �tatih 1 a-a C 1j ��++[(j�1'1�--; �/ 1 1 Ij{�� ( � tc_ssi t n ,. I`J iu olecea r,s C1711SSISTI TREET ...T iL- �1' \�sr til Zt+oermen(s Race U 1 cc Ilna®�a❑•!N r.t HIGH;SCH00LGRADUATE.OR-.GED�G ,It11��Y E]'';p' (}�p,,,, .....-�r',�` 'mil MI l , raj `9. ��vQ v COMPLETE 51111. J1111ffill.%11111U1f� NOT NISPANICit11ci?_1l{li! 1JI White211�tn { (Ina< _'s tllt;i/ a... ���llllllv eirs Name(First NOdte`La II ;l. _ 123:Pars(s��e(F's6M mssp% J.FItb +. 7 23aP sLas;Nane ore First Ma�-w I . St NR � ErGLAZEI VEYd '>- C l ORRAHAV /JVS I t I �CI !24-InfomanCNane% a-T/ ¢p(7) ". '24a:Re1aiovstipToDeteoentU !24E:MegAd&ess(Sweet And Naneer;GtyState:ZipCodep r%/" w ] uµr ? tr t 91U r/,... .,, 1,...�re�. wnlei rn10.- , 1�/ U ' ti{ rA P.ATRICIA;HARVEY -fs WIFE\ 507cWEST CHRISTIAN:STREET�PRINCETON4IN:47670 if:%7tiwy.-"11,1 mil/E]L sstea1tit tl_itit. hits] 7/J2spwan aw;S,z:_•b na\�7/_iln�\� i to,:%rectim... '��.•\��Lnt,:' w Sa'LLe^wd O(Disci 11r1Ur—„[111� 255b.RRaace Of Disposioon(Ny .a O1 Cemetery; remawy.Omer%ace) 25c.t on/:City.Tam Ara Stem 7tv .1„ '/ L ®&Hall,Crer„ 0 Dona m 0 E,,,...eerra� (/ { G 0 ���(/v�/�,� �I / v �`� '` e ,`R -iw i'snet ` ' 1IGC�\.,�! ��-�6� i i _ ? 4. ."les� � U U :26: a,eruspemyi>�111 Win SHILOH:CEMETERYdiy 0" 0.' HAZLETONitIN�ii aft :�,:"/! \. 21aln ., 26:W'az Coma ConlaaeC V !21 Name And Complete Address Cl Funeral FacHY U U Its !/ v v v'2]a`IFrneal Home lamPseNmEer. w G" Ur' •a i iv v U I l/ T/ I.I cr 6 j v •y' Il i Ui 1 k<o.,®iNe tf�0,;COL' Eu� L<HOME� ih a\\\A i Ii. 1767O _ Etuu« rt w w a, Ccense MEUNERAVHOME.INC"425:N.MAIN;ST., PRINCETON••IN,47670 FH830056Z' F?027DzSgrz'u Cl 4para Funeral Semce lxensee\t\1%?,.. 1t11% �} ��v i y (Cl licensee): \S„ \v- Q.rr•MARKRR WALFTERRCBBY,rE{L{EECTTTR�ONIC'SIIGGNATU�RE�P v'olUlllr> .4T4 �1t\11 _± F,D0�1013010'6'r 111111 _:4i nut,—all lLi itiAtL/ I11I's(G/ft�Ititlt�/-ai.IIll IIr// illilsr/i Cause Owl OeaNY(Seelnstrsc4ons And Examples) // } rrI- l't 11 omit,,! t_ %y Causesrvii. U'Yinti� Hal .0 i� L!APPto 2&h'Atl Enter The.ChRespain Of tort' Oti Orr Hitches i ifls iWtlwu Tha.D4The'Cau66'Da ot_Ap DoNie'Entot Oiiiii0fiiit Events, 1 ' fI In:ervatvOisettJl Q!t �Six3t As Cartliac FrtesL ResPa2 ory AvresL Or VerdrriAar Fibnllaam lMttwvt SI -nj Tne Etiology Do Not ADbreriate�Enta ONy Oiie'Cause On � \U� To Dea,h AC,i, Adtl Ad 2,ii: lLnesl Necessa {fie �{����� �� //' ��, la -S�' �1(F]� O t•'� ratltL(iv/ aI1U fondt11LJ ng In eat (n���t SYJI I s c t��F�RE DDUIEC o HE u �ci._.1 i i 1 ( 1 c w-e.. 2Mmeda a Cause(Errol Disease Or Condition Res.A:ag In Death), A U U U UU[t 'U�/1, `�.1N},r*' r/ V G 'fit!',,1Cv �y�t�'IL/�s�' meio-am\`w..e oP- ,� G '((`` f Sequentially List p1�tt Any,LeadAig To The Cause Lis:ed{ b. AIL U EHYPO%LEMMIIC'RREEESSSPI1R�ATORY FE URE v. et,n. �l�'�UI � I tl 1`(I; Lirifi Ent&The'Wide-dying Cause(Disease Or.Liuri liar 4uta..7.- t11It%l�tttllll%!�Y'Lp4u` �e (a �ilvc 11 ppv���1 � yam rp The Evens Resu:.'viirogki)) ott a 'C`,\V'trl\�\\ /C,. (CORONARY.ARTERY.DISEAS,,c„,,ttt'lY/l�tttltt Ile L"� .„,„ltllO�', 'UL/G,11Jtll� ,/<�>\�, r �Jul` ....., J1S` �v � \�\�_e .. � w ena��a�.�_ __ 1>�r y� .,�,��J � - 1 ea ItEe tit EnxrOYncS.ovs s.:Card;ionsCatd^sp to Dealt ButNot Ressi,r tome Undet5t.g Cause Cirenln Part I���v 'a :tV sMAAiZsZ,P��orn1eod'Vi`!/J1- LIW&" No111 %l]IIUV/ (,1 -a' UUIIt Ca(LWJII .caWltllfl11�11JI11JU '.- ti �1�IaI ���� ' ;3O .e�aTe ,�aemoc.aaaa�,i p 1 NSTEMbSEVERE MITRAL REGURGITATION ACUTE KIDNEY INJJ1JRY_..ad � \`v ` I dif5,4 ti-Ze io .S- us_ ,s,3ote�cic m✓iYes(O NoQ.. (('5"- Die ToOxmU\�� eT Dea'.7� aig.,1-11 \\�v `��Vj(�\\ \y., -7 33�Mamtr OtD212.2. �- --71 ]� l 1n, t�t4„.— ,..n.,.�.•.ve.,v ❑n.awuTna ,�ray.r eu Pin-slat-Jo on.aunt, 1 ®Nahum!I�Hwwa.l]Amdert ❑Penetg Inv.:ao-to Lk uu i�uy)IaNNNo.13 D'i �J,r^��`1 1-r.,`�._-+% lit(rraall T1 (Y ,.r� 'v,r--u.<lulnrc-v�/ r<,.i tar,i_n.]LnY�, 1t L� `� tlltte,:Itisyen.a+ecaCn.ear/L/J_ ❑Stacie,,..COW Not Beea:envred y/slIritW ?' It ll i 334�4'Date Of 4yury(Mmns'OaylYe_aps, Or 135:<TmzeOL�Innj, tSeC.`Mt!/ 36�`.pllaace Of NT(EG'Uecedem's�Hmr�e�:Constru�ctiion Siite.Reerant'Y.4oded Area\)h1Ur' 3]'Irytry At WVckt"` 1: I I?., \ i1 _�� / �/1IL�\'�\�l.St� � \"v>�Il,. U a\\\"/JII�`\�"lJl \'Jflk �\l�/JI���77.2<.���N,i/J i?estom:ron Otlryriy-51aa '�/ (.:Ma.Ccy OrT - • - 3ae:.So-eetbNurtar% (/ (/' 3ac'Apt No+ 38d'Zq Coda T/ kt:tare t ? 39.Oesmee Hov1 n� �R.' ��L-�\" —v '�.(Iyt`�{`,\(*-%•-- " ���':1,,,�\y\ -;!ail youth dlaware tzgeizn1\fitly,% M1M� i �. ,,ri(�a` milt TVi%t��/_.,1LIIJt11� --- tllI1V 'V: .F(tIItI' All' urrniniifLr 11i {%i 1 U 1<< rm 4I3S sa re.aaerseneeryrvgCause of Dead,lt%rU7l/Ju]n` Y 1 LU ,4JUU -// I '_ •,'/(�/,jtl ttltV <2;ca;i (chicco.ribne)// lIMW Il � �,1(1(1(l //c ELVIRAICANDYBY<ELECTRON(&SIGNATUREfnr<:.'CE�\ \�l1' � S�\`ill E.®ea—t wPInl nCUncor .sU .p r o. ���lil (\t 43'Narne Address And Zip code Of Person Certt g Cause O'Dea'xa \V� �V- �> �v- 1. �V <4 liartse Nirbef V I.e5 Daa eae:ae V- )tL ,%� I ,lt00,MA/t !!liar Qt o '� � 4I p� a 3 lll1]l� (p10 �/t- cIVIRA�CANE�600;MARYeST., EVANSVILLE;IN147747P /� /1_ IDl // /! 01072863A f ti-( 4/2018/. 4ec Addpmal Frmeral5emm Pis r: I y v aT AYas � Rt"35be-St St 1Mtb . E IIT ly � < Rlwlrsurar DrilrSmawaYrre /l\P �' lIin'( ICKYB'sEAGER:.VIAIELECTRONIC GATUR l � uER.242018�l a It l n iSIrltt� JUI�GD-L_Yti%.'r, ls ���USCAMENDMENTITO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) Ijtll%iLC IIIIIIr....�iCtt\'i's JACMtrltll "AP njiti 1\1 C',c‘ \O' # \\0 \ --, '\..C: t ha,. )t 5:a:eiom)5339511W7EN_T)ON ESTATE•The Saiil Seamy#s deug le-Ss:en by thus state egenai m order to pursue respaiii tiry Dis-Claiiiii is voWntary and Nere;wr9 be'ro ,malt]a ie:ilul%j.2II 0 ORIGINAL-'!.ail.—- ING TURnIS FROM ORANGETO.YELLOVJ.WREN RUBBED ORIG NDAONDOCUMENT HASgHIDDE VOID ON FAONTIFHATEAPPEAARSOWHEN PH TOCOPIED�e �Si' \ 1 s1 AN o � � o N QA t••sv Lz D ET a rcou