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Death Certificate Allen, Theresa I m _ ---SIV a[re-:✓a\nrt:-.�-7;Wr- r- a -,dl'.fr.�;l • • tv�7,lT..4a...:, P e--a» r[�._.ta.. - :?_:2 P \ tlINDIANA�STATE DEPARTMENT OF.HEALTH�? �� \�` „(�I� c `� ) t1c.,� 3s; ��p �o GCERTI� Eit�F,� t14� �� ° �� '1 ( S� L`ocal'No:99+ 0956. -I*��iEDRINot0000 000629288\ State)No.0,ji0040e. ./rfa _ ��;1.'0ecedoM's LeOri Name(Frst'Madle!Lest)se I'1afMaben Namel(Ilfemee) 2•SesUU r3.LTmeIXDeaN� 4•Da'a IXDeath• ory a / 11 a' e A+> (M .MDaylyesQ Ps THERESA,EL•IZABETHtibiI'ALLIENr <s4' NIXi'/�5��`rSllG C �SLfI J�II MMALEL:�03A8�AM 1%.�0 �1,8 �i •;10\It teat CttvredI AHmpW' 10aallDeath,„__ C___,_ 20pre�rT�AHosptbycc i `\I1,9^- '�� I:C-q� '1 1f� ?\\\�'+ 1 �\ltll\� �� C)Hospos l®Dveced�ea'Rona 1\�•N ssr0 a'loniFbrm Cart Fadirdy O./,(].Yes IS Nil o Unknown, "a Irpatien 1]'Ernapancy Department Ougmvi`�'Dead en Aran! ®t/s`,e,e) ('ry\�/ `'J�I1^�� ='L\iA 1 t�3ininl�l ♦ snGvrea. iu R.tacuiUW alU1:r/!/QUITrd/S/.M1'R IKLr[_.�:ZS oru`IW� _ ti�na niV l 1weary Nam"'NNetlat`fcn:Gns Street adNvaiperrnu C/�`III yv� . (V � Millo,1 910 SOUTHIHAC<STREETai iJll AII � 1111ff11I1�L<'�%/� 1 111y,3y11rainlM ttt 1}'l�'12'C4y Or Tmm;Stra:And Ad Code y \aunty Of Oeettre \} 14 MaMaI Status At Tine IX lent r4in, i. \ unforced P.RINC� 7s O -est IA, _11 Iti1�_. 1 ll!_..-. � ��lu)){ GIBSONIt��da?11111111�21UVi131�;0rwaste �0° IcI 15 s sulnrp Spaises N11 lfU U 15a last Name Before Feu Manage o 1�$`2.,BA`�, dents Usual ompanca ` v l ae:ne\Mauryr i GENE ALLENI it ft � G `t:c z� n�..�\\s I�L II BEAUTICIAN ..., COSMETOLOGY 1 `�sYa:'Ikeseve_s sbb / I G'y r-a� Ny�{{,xx` �pi(%! IXU� U !N�' er r INDIANA> GIBSON -.a P ETON. � r�,uec�/sr,}e[e�tAw.TlN�a/rn'er ,nt��{��{�//�� Ygg. •. ✓��flllliert flUi1V� - 1111 a \�/� �� -'>yt I ,)d10a S'Apl'No.�y/1�h18e c2�Cado 1 '°'edae��1�� «(� 910'SOUTHHALL STREETS e% ,1o'4y�p � ; llll�j%CSS�St1 �13 l//�/v////ant)" .I .,bl y`�l_SOU N� 1 (� 19.,Docedenr E{du�r�alm`�Qy *f20.epecedan Of Hey Onpn �� Z�21�painn Ram r s ASSOCIATE DEGREE.(AA AS) L4 NOTiHISPANICA ��' 1111UC..2 White .?°n4:1 It! ilT?•Z2'Parc,CssNName(e(First'M�gcerllasgll \tun: C 23•:ames Name(FrstMixIeMastr rV' a;23a!Parns LIM Name Fist MartiageI 1 EARL ANTHONYINIXrSR <:. GI" G MARYIAGATHA�NIX � FISGHER ^:atia ii EN'IrNnnanThName pa4ttli ��" 24a1RSa n2p•OOemder4 U ,,bi L.1\ cc 125a`Medwd Of Disposi:5teanti iulII SEPflEMET : Of D1s 1(Name OfCemebnCremabry:oma Plam)M•25ceatontCi4Tw.nMArd steely )){.. _ O cc, W%1®Burin,C. ma rkfaitYt❑Doneboe OLEmanermnt �r(� UERyC, P,RINCETONRIN ..t>`.7e.... 9. 2a.WasCaanc CPrlaCaTl (/ 2T'Nam Ara Compleb AddressOfFu�cal Fattty �'d r/ `yj��p��-7j' (/ 127a'IFueral Home License Number.' w1I1UT 1��N:FUNEflf SHOME ld N.MAIN P NCET�`WIN'4 67.0 8300l; �/ p Yes ®.No J ��,� G { \ra COLVIN;F,UNERAL<HOME INCp_425.NMAINtST. PRINCETON<INC4Z6Z0 F.H8300567.t: v l I- s2TOK5pnannOflnaaraFaer•Service licensee:\t\v \.\n. �r�: :T71� 2TcILkenseNuMa101Licensee)����v ���� LLJ yy� RICHLAyR�D D�yEpA�LNrHICKROD�tr?�B//Y�E�L•E{C1TvR��ONIC SIGNATURE ?Jll'llllal' >.'.dlla , ED010121531a�aYl216ULYL6 }n`fn`Y!/1JU111»:, V' vs.lralati� slE��F'L'1�nralligi -J Grusi Of DeaNs(See-IrmWctlmsAna E:amplea)1!/JQV,t1I a.,t' ®I p'pproxxvnalef (1 28:Pat I Enterihe Chan Of FvmtA Diseases1 4yuies Or Coma,catice That D The Et se:111 Deatt�DnOt E&r inimal Events l ;TIP \t • lita aftOrsM G k )suCSAs CardockiestrRespea'on ArresU,07.Vaciilar FmnliaUm V✓atorl Stowinalie EtobglDONoCAbbrenate Ender Ony One Causes � . ;\'�: T-6 De ifi ' _ (�A'LnepAEil Adfft'wui Lines if N' \1 al \l �Vy� (p��v [�r/JGIIi11ttrGlti11LTC�/.f4 ik -,X7' ��n 1 hIbali aTl!/41 tqn f ��'I i ❑Llln ,1 O� 2lmmedbte Cause(Fuml Disease Or CcodNon Resulting N Death).:2It A/METASTATIC ADENOCARCINOMA OF-THE COLON❑ 6iI Lill✓!%lt]UlI6�L/11 _18 MONTHS✓�/1' Di O b- •• wuma.srwe�4 onr< a I`-j SequenWaey Lsil % tt �oLThe'Caraei• - 0 a ti '.�e'ly .i `....g:ZU18\ � G'>0 SULS A En.eTThe lliebh v Cause(Oaeaso Or e:CaTha11111I12LBd� ',, I QJ �� �r(.% Ytie Everps Rla:4wy in Death)Lash �y,1112 11Ulll�%J111]Il1�L �_n/� �� 01t,lree�UllllL ��\\ �41t�Y`�/j/��yy..y. J ouep..•tnw.+ ai \\?-...IYE 1 D;\ s. GIBSOWCOLINYYT-"X��ACIDITOR� (L LPr I br OTCGrtii:calt f eiCorr Death BNN sJGSG�,TfltflnCau ten In It% I os'L'i,AUAoa� utieArt JD I'eS/L®-;,, LJl1IlLLL/Ln ) rT >z� 1 .eS\ _a oit v�.IF�u��nTLiv�O<s[ao vIXevOe�f4sn��OasQ��No� �t3c•Did Toeao-o Use Condor To Daadii '32�I/Femair. ` `` r 3J Ma DLOall \�tK\`� - ((/ '•'�\� f.IR � Unknown no"n (1O MgNet4III ee'lw/�(]R.OW.4 211.1..N MY R.TM1 reSe a PUI .a0.0 ®Nee. I]IHgNOY Q mic-f I]I rts.,, LMeeapOLal t✓e t]Yes O.ememy®No Ou (-- lam aPwridc a lT.es I m��/om Her,rnaen:�nn.mu 1 �i-usr�o,LOc•����r�a, 1 '//{1U'1l11t_� 341DaasOcnitlP(1ua!Iln)l • 1o.d4n eur.o.wao.l.*.s>We.e..o-�uul�ucensma•vvanin.r..rw ❑'Suede;�' Cold Not Be pebrtwis0I:1'�yV111111111 �j :'.. 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