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Death Certificate_Shackelford I —�^d� INDIANA STATE DEPARTMENT OF HEALTH •.{ CERTIFICATE OF DEATH -RESUBMIT_ . Local No 000147 EDR No 00000065099' 4 (,_-----341 State No 031183 • I Deed.Legs acre(Fret Mate:tasty. la Innen Nano Nknto C 2 Sea 3 Toe Of De a D a .s=(Daavtbytr, GERALD WAYNE SHACKELFORD ,) r On MALE 22:10 j 0621/2018 -. . ,0.9 Den,Conn in a Papa'a. lCa SDri Ov Se ac Sennett O Thann.A koa . • - - I S7 p Ynt 0 Haan Frail, 0 Doan tam 0:nave Ya-.tanara Can Fatly 5 0 Ng•0 t t-o.n a wean?0 Eravcr Drgamet OU:.awa 0 Can at Anna a on„.f ) Q It.Fact)nem'Cr Na InCaces One Sava anc tercel ST:VINCENT EVANSVILLE.INC ' T 17..Ct Or Tfat$rJ.AXDOCaa 13 Caret CI Dean Mara Sias A:ineOlee , - •A t - ar;Q e ..tQ tine.&,sci Y0 ❑Main. n EVANSVILLE,IN.47714 - VANDERBURGH 0 wage 0 Meyer acme 0 u4n 15 Sane S@aaa Mn ' I ea Las are Baas Fox Yarcpe IS D.�ferYt Usual l Oc li !it a .vt 9esi,.•asrt JOANNESHACKELFORD f TRUSTY CARPENTER I LABOR I .9-Reaeno-Sw ' tea Cant :S C_'1'Or Torn - INDIANA _ GIBSON OWENSV1LLE 'i ..; t1-Sre.t.vn escoer I 'Sc ha.No. I 47665 lee ZO Coto IS'Iran Cep Lent ..I ,; 205 SOUTk THIRD-STREET O YeS.O No 19:D.mxrs EOrrat - :g Donee"CI 1.spari Oran •21.Decays Race L - - - 9TH:,12TH GRADE;NO DIPLOMA NOT HISPANIC WAit_e. . a Zt_Ptrerve!Iara rIli.uw.:tat t :J.Paalt Naga ffra lees,sett 23a Pear.x tta"a Brae Fro Ma:aa' f DENVER FRANCIS SHACKELFORD. -- DOROTHY ELL EN.NETTLETON WALLACE :.?ce, •la.as'..art:tsaa 24a'Remamw Ta Deelees - 240acre Aatas(Sport AM NU:5C cy:Sta.:a Ca) - r- .. - I -1 Dt' JOANNE SHACKELFORD_ WIFE 205 SOUTH THIRD STREET.OWENSVILLE.'IN 47665 - ' :t . 25 Ran aGteacm- - - 2LMa:a:aDupotavt'.". - - 25e.Place a Dr0 (t e a Ceara,Creaotay.Ore ) 25c tnraf i.Cer.Team Art Sx. - ". 0.12aUl©Ctmea, 0 Onto,0 Claiectra . Q Rcmafran SLa _ • .p ara5o.a,t /Xi �a HALEY MCGINNIS CREMATORY _ OWENSBORO.KY ' ''--' 25.vaa.aa+eCasamet Te sue Caron Amass As Of area F. �a — - Zia Eireann,.Lana?Ana. i' . 'Rrr' - te•, •CI-y . , HOLDERS FUNERAL HOME.319 SOUTH MAIN STREET.OWENSVILLE-IN 47665 IFHT 1700008 T t at 5q+-n a Vera Fats Srta is %c - r- 27:.lane Harmer(Cs Etaney" - ' • BRANDI MACER:BY ELECTRONIC SIGNATURE - 5 t ��I ., Cause a c Dean(see hu Ym E tncs Ana a pla) . airse m a Pr I Era(Tie`Cnsa a E.a'ts -Dasma.taxes,Or Canptiatau-Rat Dicey Caned Re Dead Do Not Ens Te,.ram .. lower Drop Art;;As Cain Most Rellnery Asa,Or Vemotr Ft,Klan.Stoat Re Etiology Do Na Amelia Eller Only Ore Case To Dan A Lie.AM AOitiaul laweNttaaiay.' floe Can.(Fry&roan O Coi:Co,ReaIng In Dean) A CHRONC CBS TRUCT1vE PLRYDNARY DISEASE. LONG STANDLYG a.a..........DEC 2 0 2018 5epieaaH LID tin?:erg BAa/lcae To Re Came Ertl On B - (.`rL CG Lle'A Etta The Uraer0ex Caane(Deam O trtri Rol t.•:ana �I _ y` Re Etwta Raa,ILY hDan)Lra.'c C _ 1 10 a.rp.GBSOfV COON f -r ra C a JR pa,a:e Ow a'wa-n r,raa+r't ram n',toCat Bis Na RBCy to The'A e'yse Can.G'a In Pat 1 29.ahs ai Aest tt c eel : ' l ❑Yea 0Np_win - _ N'DriP _ ,.• t.-Nr A•JSC.y Heat a*nixie To Coda De Cana a Dev Di - 311.OaTaam ee th*Co oD.C' la'. '. 32. Fes • 33.urn.Of Dear, ❑Ya'0 - 0rd Q P„asiy 0 No ,,WNe_T,, 0..0'....,.....a. Q awra.-sage Chu'see,rn rye rc Y..a3.e Q antra 0 Namoe 0 Azare 0 Peere taen.+a, t 0 a"'wee e.rry..ere. see Meer ❑Man tote..De ❑Suede 0Cale Na BOOearaee M t - 3r Da a at e(Ibrt,DRy!'e' :.- . 35 Tee O stay 3B Race Of stay lEG.Oacrcrt ram..Caacer Sae.Reswn Waned Arr) 3T.tray!Ivan? IT I. . IOY g o Q w 35 LLTGna hay-SF* I Sea Cay O Torn 3Fn.Stec S Na-�er 33c Fa'!: Mc to CadeI ' ,� 3:Cam-a!aa Izsy Qins C a T.a..w+ ,Slaty Sect yy Iaa(w.n. Q'^as Gas..Q. mcr y to :. II.Sgan.OPaar Car-Jim Can.a Dusty KARL.WAYNE SASH.BY ELECTRONIC SIGNATURE CI�cp:yc a r 0 Caw .0 tam a e=vt± U.ant rat At 2n Can CS Perrot C.rltni Cane a Cent• u Lane N:rq I 45 033102350 i ; • KARL WAYNE SASH-.3801 BELLEMEADE AVENUE.SUITE 200E.EVANSVILLE.IN 47714 01050566A 06/25/2018 C Aa.Jaa Fawn See Paler, AT. wan I tyre.. t - U;$gwa.a Lea N.s.awn a5 For RegTsarOroy -Dee Fat laieeYDatM1eh _ BRUCEBRINK JR.VIA ELECTRONIC SIGNATURE JUN 26 2018 • t t ` ,. - - ' AYENDYEYT TO CERTIFICATE OF DEATH(ENTRY ORORIGWAL) ®SON COUNTY IiELLTiI DEPARTMENT 4:c: (.1) ..... \1 e.4. \..-at "" aea _ coo. \:_k--.) ...._0(3.a r • ; Sate Fan 53335 ARENOON ESTATE Re Social Seaag a is cave requested by Vn ass agency a craw to tune rest/-ary.Dsdwre is:canary at Ewe a R le peat,fa total. WARN I N GGIF AL CCC:WE)T HAS A UV.T1COLORED BAC..GROU::D ON SPECUL WKTE SEQGITY PAPE STATE R AND ThE GREAT SEAL OF ThE A TE OF INDIANA at SACt TINT _I •• CR1 NS fRSN O ANI)E TQ YELLOW.,AMEN RUDSED.Onn!G WAL DOOLYcta HAS A W DOEN VOD ON FROIT THAT APP- WHrM FSq:000nI_I ' t,a rap6 63iJ �.`r.�i -r.7aaFA 1 -