Death Certificate - Bush Jr, William O_10/24/2018 Fit a. _ - _
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.WILLIAM ORVILLE BUSH JR • ettill MALE ill 09:18 PM 04/13/2017 ..
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'EVANSVILLE, IN,47747 -& �i N'' ®IlmbepM.e•gEtaSepead p,e'
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WILLIAM ORVILLE BUSH' - Ate: BRITTIE ETHEL-BUSH �t BOWMAN . - Rom.
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•LAREIITA BUSH O N WIFE • 201 NORTH SECOND STREET,OWENSVILLE,IN 47665 Atn...NIP
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❑Yen ®No - HO_DM ERS FUNERAL.HOME OF GIBSON COUNTY,INC., 319 SOUTH MAIN STREET,
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..+ OWENSVILLE. IN 47665 'LE pia 890000216.
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RANDALL K DIKE, BYELECTRONIC SIGNATURE ••,n.. AV FDO 1A7 p.,.. IDyI•••�'
i rN� ".A.' .�h Of Death (See Instruction.And Emanates) I ! cdr'Appr�ntB
12Ry Part I.Eider The Chat1 a Font% -Diseases,I juries,Or Comp6ratan-TAM Directly Caned The Death Do Not Enter Tamara]Events �,�@� Ioevat Onset
¢Sw.As Can➢ae Mes1,Respealay Arrest,Or Venetia FbTaten VMhout Snovip The Etiology.Do Not ALaevele.Enter Only Ore,Cane Onn ♦ To Death
CA LS.Add Add/hml Lines a Neess ty. 4 'Ac `a _. . 06T 2 4/2018
iremediale Cause(Foal Disease Or Canaion ReaCOg hi Death) i A END STAGE EMPt1YSEMA L .„..
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I,Soluasia*y List Cale icm, If Any.Laadh)g pa The Cane Listed On
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The Everts
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Pat'Eisler Other cl jr+nt GancfrtiOns CanWWe to Dear But Na Resitting gm T m Underlying Cane Given In Pail 29.Van An Autopsy Pertarnodl • p yes ®No, - . .
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-31. Ill Taal®Use Catba To Dee9i7tyy1W 32 M Female: •. Feeigall 39. Mona«Dente A\
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34. On atjnry(MansDaylyear)Was 33.TOn a MAIM 36.Racea qua(Ent Decedetss Nona Canso-umbel Saar Runrent ayod•d Area) 3y�OLay At Nark?
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CHESTER ROBERT BURKET BY-ELECTRONIC SIGNATURE ' ..+. 1 �`?q ® eAr Ca °Pnystlen 0 Coroner 0 H41/11910MCONe
43.-Mares.Areas*AM Zip Cede a Prdn aectiy CauseDear ,lg Ce a _ -St() License Nmm er 4im O catSO
CHESTERIROBERT BURKETE ,9200:HWie 68-P O: BOt580, POSEYVILLE, IN 47633 01029806AT 04/17/2017
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ROBERT KENNETH SPEAR!'wIK LEOTRONIC-SIGNATURE aNb. 4 - APR 20 2017 ,aruSliB
pub _ . -AMENDMENT TD CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) R111-tsre "
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Slaa Form 53395 ATTENTION ESTATE:TllsSodsl sonny'is bat teprsfed by at.nag agency a army o prate res_poME®y. Dsdmaa ti vdaadary mad Mall we bs no penny la Moral ..
WARNI1'l • OTTUwRNNS FROM TO YELLOW GINAL OrgalThilENT HAS A MULTICOLORED
RUBBED ORIIGGINAD LDDOCUMENT WHITE
HAS A HIDDENE VOID ON F PAPER µRONT THAT THE GREAT
PPEARS WHEN SEM.OF THEPHOTOCOPIEATE OF 6ED. - THAT
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