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Death Certificate - Perry, Diana Kay_10/26/2018 1�'� r � /r� '�' `t�.,.�.>�rr �."rT CERTIFICATE OF DEATH � •r � .i^ ��� , K�� �--a�A�AA 91 1 � �J�' 1 3.�:'a'61rIsi- -- g- v0-:seq.*.'�'. �" )" , AWN'''•. r a /' �� ; 11.1 . 1 INDIANAtSTATE DE.LARTMENTtO..". `TtH r �Ii 1 I i '��� i � 1 `,,tt� � ` GCERTIFICATE�OF DEATH �j �{j� j rill�� t �I 1�sC�ti VT - �k /tgear.3 ;;,,� ' , ai No 0.00202� Al, �EDR.No�O©00006635�1sZia state,No.04'992:1 �. _a ���rrr.l ltltlitl Le9.a N,me�Mkd¢;Last) //s11tt tI/J��,(�4 ta'�age(n,�N{ak,Uy(If female) 'Sea �3.:ime Of Dew ai)Dxe O'Dea'n lM��ay'11Y1e`a'r�) : `,A.DIAl1NIlAI.KAY•ERRY�:t }•A v N. r/� 1 (/V ' NS•s„ 1ALE 03:i��/� llll2/2018 �� �'i BYRNS� FEMA/L/E 03:OSA11M� / .,d09/02c> , A Hospal� LI• V t{: ❑aIest e-o ❑un..,oi1,❑Ippatent t t-at ❑lElu..o...rel a mioemi.✓°/"��dl�i in,.... -Lrer-A..n�eaden u'�'�';v ')Lu �ll t13t L,Ill .tl,H C / ii.'t Fealty (LNa Ns lha>.Give Stay ardhunter)� %- y' 1 t1(!- (///1'' t�� �.� 1A1`` � @ '4544 WEST 125TH NORTH lu7!.,c ii11le.!;5 IIiiii = IIIG%. W11�/ ^•,4I'// V�IIU� 1II��s...e. ]piC//� 114 j )I/\ UDrycrrownsapiA-r.-,- -L r ; i/...: � 1 �"" '% 14arlaaN..,`' �v 1a Ma -tattAtre„ern... ".2.4' 3�tt 1l'ii If ' � M ed❑Hamad But �' a � I >�-{Y �� l�1 �a F❑ 1 se'Pa<a_ed�®Uvarem fg PATOKAIIN 47666 l Ft u.11ll��N.t GIBSON A: .] 1G L❑Nldawee�Q;Nere1M�nier P.9.ks,o%n!/1' 1` 15.Savrrm`p Spouse's Name 1 .r I u� U11'' or— .j�l, 15a fa t Name BebreFirst Mamag .ctmN t0'DeceJen(s UsualOmpaton��y Mt j1]<Kp,d(,y l3usmessAnd,a l t In. 'A�r i li�` "ll , /J: \ 't11 are. .o ti 2! %�U!�.Cic ���� °4 s' t VlN_\, 1 /� t� oltiln- .� n_' G SSG GI�Y/ 1 CNA� e HOMEtHEALTHCAREn_. )v .;:a:Re sure i f� I• 10a?Candy ,i.' 2 tee Ciy OreTown' 4 / • I [ L; 1ir I v ..�1)l 1`1 :t111 ` �at(�� ',�� 1�1 rr/�1' � �1 ��' P l/ r%1` !``� It INDIANA��� 1..��\':"� 1 GIBSON}� { °c am\ i PATOKAV .\\\/� .\1�E =� �\�`1 Ajv.'fat And Number l ;;��\.y/ 'ti 7/ t I �. \� - �� t \clad-Apt N p 16e�Zip Code '13•Imda �%11�1 .—rIi T e 1) / p I, % r/U//J AI ><,'SI �U x 43�111 14541 WEST 12THrNOR rtkli I, -a U�(i2G+lr � .n t'."�CLLI`O �����-.C4U.1li1�Si�e U.1�47666"�V- + -®Yes o, l VN /;y�ilg�Dea7Oenfs EOwbr` �'It,\�V-'� � Ar,DeradrtOt WsPm`On9��l Q�ci1r21:�Dnrodet(s Race "� �V �V �. ? 9TH',12TH:GRADE NO.DIPLOMAlit NOTi^HISPANIC %—.2 Wtiite %%se;�;A'� �l(s Name(Fast,MdGe Laso\ r� },r/ P cR•r '}yil �1}1,�1''23'.Parmc Name(F rst''M�tas0� y`Iq H 23aa!PParem1'stast Name Bowe Feat Mamage1 ��. Cl ` V�" `Stu \ /I 4 (II = � E"��� 9u �1 D \\\GH , MIl M DEEMARaBYRNS its . .. �'.Iln /� L BIb.Ma ngYRNSSSEae Plil��04 E3s� �' VAUGHN� SLR ;;- 2a:InMmam'aName' 1} 11 iG/'!�I •1 11 '2aa:RelaSmsti�Tp Oemd«n2.o:Maa"p Admeas(saaet M,e Nanoer;C'rystata: G/ 1 q+�• t>lrntz1N,.)•l III . t.� //:icsa //�UU,1 re,Atll/1fir=",z.re iertyatilltl��jeytiimir- �,uini{�n ��1j1 ▪ SHIRLEY_ROSE r4--. _Li SISTER/Ili '419:SHARPAVENUE;:MOUNT.CARMELQIL".62863E�\\ 1 Acc3..'N] Ott\.\.\�Yn\\\niO1 ' :?).c�Yf\\\\�.0n�\\\QY1Sitte 251E bras: �\'��2n i..... l2RS":"..am\"i lC\\\tZli'his- i11L,\� .A 25a'Meelnapt Uspas;m / u1 Lv 1 25a Race Of Dispnsiaan(Name mCemeterY�Creruavtelto riara)Y:25cl oen_-Crty.TonAnt State) v // i itt.• ✓itStff ' 10 ❑.tiac®r.,,1.1 i,❑Daamn❑�Emmtmw lU (/ ' I/ U II 1�/ I ' 1'� �/L--vA a'l ,sM Ii I� I�C< \bids\LEI �� \� nC ) A „t t �� ��U ❑Remw` 15ta:e • Ln` ❑rn,er(specyuu,,r \\ � EVANSVILLE:CREMA• TORYs_ _ EVANSVIEL'EINT_ , • vas Carafe.Contacted? 2]aName AM Complete Adaess OlF al Faairy U 'O� I' 2?a„F'naal Hare licence Numter,I par nVI t , .�nrttitf n �� III i N`�_ Itrazrrt - tmtl tilt frekS�>.-.410 - \1t1 IAI PIERRE FUNERAL'HOME�INC 2601 W,ERANKLIN STREETGEVANSVILLE INL477Al2. 83001897�r'..� j'J 27a..sgnasn 01 India F eau Se Lde, `\\\S�t\�1�v' �S-" 'ti:. ��� \l )2]citicenseNunber(Of Liransro)'� ry�,,"'`�� JAMES'A,Pt1IERR/EE BY'ELECTRONIC(SIIGGNATUREE��/:2 . f.RMAIl 4 e�lllf��/. F..ttD�1t21(9{400000000778 . .. Il lv� .,111L1 1 0 '1 I /,'. inni?t'l//�Bittlt��tt11t1lllnttt//leActer-Death (SeeL5-u- gP. E i ies)tr/ II I'1LI I'i ' r at atelt i>ea�se �aa c ot nti3 u Q 'YTill k 1 1 28_Pan I Enter The Set. (N F ny Diseases a,juaies a CeaaW.t o That ig The Caused The Dealh1Do NoeE rder Orm'Inal.Evems t',1 ' To D at Onset • • Stich As Cai'lac ArtesL a% It ory Artesti ,Vemieular F,MlltJa,NkJrout Showr,q Slue E tly7.1 Not Ahbrevlate•Ely.. ONy One Cetae On TO'Deait, \A'L.»DiAdd Add:ional Lines If Necessa �" � y � \ 11\\ V .j�•, 'ii�litiCx�//�1un�YCaildl�et I gO RTFATL� 4 tt // ika 0 1 idlmmetllate''C„{ause(Fnal Dsease O/�r�Ca)lN id,ResJ/t�rlpIn Deth)r: CONGESTNE-HEART FAILURE � =. i1 WEEKS\U 1 L is hit\\\I Uu ..v,a...... , (n (/ // �L41(�i U uU U u 0 yvU 1�{1u1 \ S�k equerk,ally Lisplf Any;Leading TO Ttre Cause Listed On B. � ` �1�: `.\.\11 \ 4 1 f' t;y L'#ie A)Enter i O Cause Disease Or"-`Tlrat lnitiiiiire i(i t,rI1(w --.3-.3 -.1��ar,,'a(iw�.m��w .,1,„wr... �I���t-p--, Len� ,L/�711(111 I j�t f�,1}Tlie Events Resutik g�In Oea 1Last(... ��e/J e%C 1114Lea.'Itllll� 1tT✓l iltitMeei allitce t1t1.1 :1%!/J�lllll�(]� O'�✓ llik il I «%�11Un�t� r' I1,`I`�11'{�a .. 1 e% c+v (l rue nla w.c/�.o n� F �fY� NY 0 a' 'Part B.Enter OTa_$wnl5ce'ICaq,;xx,s ContilW.vdto Death alit Not Resu:n9ln The U:nedyinp Cause Given In Pelf 29T Was An Autopsy Performed?'t—'116. 's7 c.��/��y�t{� // • - `) 0sC ��JJ�� t7 F s la.Tr //dyi terra V�1✓ 1 tuna Jnuutl�orJUI,�C ,4G'❑e,Yes//®.No.tf1�Y_�/LJtlltt�iifl - 1 t TOBACCO ABUSE M 21 I411I�gtl`li!//6J�ll iOOe 1UU O. fuirialFt. aia,let ta.vtiuTur- 9tu,!!❑e_Yesu❑:No n TOBACCOABUSE.-0IABinill III - ,at IMT\L31:Did Totem UseCarink:eV°DeaT?k T v 32.I:Female\\`�tl;��\��'1K�\. ��,I I:Ig 33 Ma_rv,a Ot DeaJc�\l \�1 � t' \` !!a✓'rt-%\�V/411\\\v l4t 'SI ®lama.+ ❑Awwv_rmea`ani z.smnrine., ureoo..e. /! `1^'� J�!„II I �0(rum ®E.Sfdel❑,H- 'avaaa��Am.eNd N`❑Pas'+51nr�gll ,l ❑Prmacry O No ❑un.nam ( tii/iltlt,Nj�t Cit�l i�tl�Tt� /a�tns. �ittlCn�% Ui •-.�•i ttl,tvy�11� l/ 1(t1 r1\ ie 1!-Yt�®YDI�i�fUUu�! s.1- �❑ro°'•w_a. nan+ao.r. _ ss.m�11U1❑' — sn va=:,t.r.. ..� ❑csw.❑.CaD]Na Be Dexmvr,M%aV.'.1",�`�Y/GIIIlJlt1 /4 34. Dap Of Inpvy(MONY_Daylvear), � 35'Trne Of Injury - 36 Ptactefatlryvyl G tDecedert Hare; Sit Res3a U11boded�Area) .137 lr xy At W}r�W?' I • -C▪i ,1jry1c4411 L T .LIN �u it l � �t U✓Coosa-ter J!� ,,,,,,,,��������{{{}}} y ❑�Yest��j❑�No u 2 ka c]r.� A�-. 'A �.. a!ls.AA�` �o VAS_ 1 ti-38.LnaSnn Of lrlay Sap / uG;36a:Csy Orrjown e i ps_ue_sae 'Nun� +- k3ec3ApL�o% 38S�rCope ,39_crcnoe Ho�w�lrPvyucNu ,�\\,yp � , ` �`.\,!u' ���` CO_.Iu,T e Q .v. ti, 1 \� r -j 1I T.'ieV z�.eS:'> O]IIIM�YI�JW(t� JlJltt\�^ C I�JII ❑ C ❑ `''e av^ ! � n, � t az�y/�ldtn�%/�u[l��hutii�s� :1 /:<1:tsgture Ol Penneerying Cause Of oes-tlltIm (811.Cvflt11111ULr///1,1, v/5'1Ut ! �% II 42 Cemte.(Ch«k ONy Onej/!/ 1p '�ti•'''' RICHARDMICHAECLARK' BYeEiECTRONIDISIGNATURE 111t a6�ril,,! 11II!®ICMLym9 Pi,ye'aa �111 ❑e �lllLIlvO�e i�II \:UJName Addrw And Zm Co]e Ol Persm Cetyvq Cause Oal DeaOv� �a \ ..V V\I i4 license Hunter c��� a5 Des C.et tl \mil <� �, datln��i, l� �� A� lllllt�� � 4]0 �-+/ �! 'n�\�j/t ItV .. �4, .. (gyp TI • l{,r�E. D RICHARD MICHAEL CEARK 510 NsMAIN ST .P.RINCETONt INt47670 ...a / 0 id 5 �.109L13/20,18�I ca-Add m'W F- aS. Plcvder:-' it {ram I .1.---.,-,�/' U 0 (/ d% -l/' U U/ (S 1U is?Z'<iL .Q`v '171Q-rc UL v 1.r tia��i _ is _ va%N1121Ia4-1�i III 161 40ISiT✓read LwlHeaYt D'Sa?r r1„�1n�X.V.�) ��" \1 �-• \-49�For ReY to -iDap Fded LlMan IY }. ~,G BRUCE BRINKeJR VIAELEGTRO„NrIIC1lSIGNATURE 1 a-.�e _ \ f�! �.Iltlln��% "�II�f ��IU(tPR�OGTs�In" ' 8a/� 1lAt ,%E inuG�//�4�1airlrfCen LJIV- LY1�UiC!✓/LtLsitinAMENDMENTjTO CERTIFICATE OF DEATH(ENTR�OR ORIGINAL)Jiidn l}ili]ill Inllr///JL.{ IAi j!'/�LL111111 a r � ) a�fi�d �]�t''. p GIBBON COUNTYY, UD.TO� �' ATTENPOh.ESTATE Tha Soaal Searrty#Is bang reques.etl y,Ws state agerry in a�'ar to pursue respons oLy Uiubsure s whmfary and there will de no penaky f a ref sat y.Q >_/ tel �/d I uH-iel-. 1 soulHA lunIt.:1/ Iuullev//D0N S _r/-,1[ID w:UlUlln'✓/!._A1Un'.EJ/J11111A'vE STATE l.11NPIAXA NBic-le( T (WARNING TURNS R I.OM OMENI HAS A MULTICOHORED BACKGROUND ON SP CCIAL WH HAS A HIDURITY,PID ON FRDUHE GREATiSEAL OFsTHESTATE OF,INDIANA ON BACK THAT A _TURNS FROM ORANGE:TO:YELLOW.WHEN'HUBBED.ARIGWALINNIMENrt AHIDDENNOID,ON FROHLTHATCAPPEARSWHENFHOTOCOPIED. a'je/ 0