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'A INDIANA STATE DEPARTMENT OF HEALTH i
� (it - ' 21 CERTIFICATE OF DEATH
(.�_-�' Local No 000267 EDR No 00000068 il
3596 State No 063886
1.Decedents Legal Name(Fen.Middle,Last) 1a. Maiden Name(If female) 2.Sea 3. Time Of Death a. Date Of Death(MonavDaytYear) \
i;
LINDA SUE CARTER PARSONS FEMALE 09:28 AM 12/23/2018
v. 5. Social SecuntylimeNurser fiat Ape�Yrs trot Under t Yew Sc lime t Monti od. Under 1 Day Be. Under 1 Hour ], Date of Birth(N.on:N &DayfYear) 8. Mplace(Cityand State or Foreign Gauntry) �
Forces? 10.If Dean Owned In A Hosp:ul: •. 10a It Death Occurred Somewhere Other Than A HospW
O Hospice Faddy 0De.sl,a'sHome ❑Nursing Horne/Lmgterm Care Fatty s
t, 0 Yes 0 No IDUnknown 0 Inpatient 0 Emergency Deoanmerd CkrvercDead on Anwa
0
l 0 Other(SpeoM
1t. Faa.y Name (It Nor Instanon,Gee Street and Number) '
106 SOUTH 3RD STREET ?
12.Gay Or Town State.And Zip Code 13. Carey OI Deao 14.Mama!Status Al Time Of Deady
0 Marred 0 Mamed.Bun Separated orce Dive
FRANCISCO, IN,47649 GIBSON 0 VMaaaed 0 Never Married 0 Unknown
t. .5. gaming Spouse's Name 15a.Last Name Before First Marriage 16.Decedents Usual Occupation O. iCrid Of Busressenaary
"l DAVID E. CARTER COAL MINER COAL
14. 18. Residence-Sae 18a.Camay 1so. City Or Town
S
INDIANA GIBSON FRANCISCO
19c. Street And Number 1W. Apt No. 18e. Zip Coal 18t-LsideCcy Limas?
106 SOUTH 3RD STREET
47649 ❑Yes 0 No
t 19. Decedents Educaton 20. Decedent Of Hisparec Onpn 21. Decedents Race
HIGH SCHOOL GRADUATE OR GED
COMPLETED NOT HISPANIC White
22.Parents Name(Fast Middle,Last) 23.Parents Name(Fist Mddle,laat) 23a.Parent's Last Nara Before Fizz Mamape ,,
WALLACE ALLEN PARSONS MARY MARIE PARSONS WILCOXEN
it 24.Informants Name 24a.Reamed:up To Decedent 24o.M.aIng Address(Strew Am Nxxr,City,Sae,Zs,Cede)
1 DAVID E CARTER HUSBAND 106 SOUTH 3RD STREET, FRANCISCO, IN 47649 e
I 25.Place Of Disoos:.gn •
25a Menoc Of Dspoz:ton 25d.Place Of Dioocs::on(Name Of Cemetery.Crematory.Other Race) 25c.Locator-Cry.Town.And State
0 SAW 0 Cremators 0 Gannon 0 Entombment '•
0 Removal From State
0 one(Seedy): FRANCISCO COMMUNITY CEMETERY FRANCISCO, IN
, 25.Was Coroner Comaas? 27. Name And Comp ete Address Of Funeral Facility 27a. Funeral Hare License Nunoen
❑Yes ®No COLVIN FUNERAL HOME INC.425 N MAIN ST., PRINCETON, IN 47670 FH83005671
T b ILE
2 Signature Of In Jana Funeral Service Licensee: 27c license Nu (Of Licensee): e
I RICHARD DEAN HICKROD, BY ELECTRONIC SIGNATURE I mber
FD01012 I
Cause Of Death (See Instructions And Examples) imade
s.Or Complications-That Directly
Zo.n As I.ardiaThest,Chain - st.Or Vetriune p Caused TheDes?,reNot Ern Terminal Deathat Onset
A nLine. Add Additionaldd A:esL Isay:,Or Vercriofar Fiarillatign\Yitbou:.Showing The Etiology.Do Not Abbreviate.Enter Only One Cause On To •
' A Lines If Necessary.
Immediate Cause(Fetal Disease Or Con tort Res•Sa'ng In Death) A NON-ALCOHOLIC CIRRHOSIS Die e re,..,oiroverve On JAN 14 2019 'YEAR '
rt ifseouerW ll List Coneons, If Any,Leading To The Cause Listed On B. yort4• �a r
Line A Enter The Uncerl Cause(Disease Or Llury That I.nilialec 1
.1, The Events Resulting In Death)Las: C. &air ,r
ow cuts...:oven at s s
. D. GIBSON COUNTY AUDITOR j
Pan II.Enter Other Sinn:.cant commons Cofrnb tno to Deem But NW Resultac In The Urcertyvg Cause Given In Pan I 29. Was An Autopsy Pei-Nemeth y
0 Yes 0 No e
NONE30.Were'u:x Ft-
Ph;Mug Ava0bl ae To Comole:e The Cause Of Dean? OYes 0 No
' 31. Did Tobacco Use Commute To Dean? 32. It Female. 33. Manner Of Death:
Yes 0 Probably®No El Unknown 0 1e...awe yawn rearm, Preps.*At lima d Nan 0 w,PreTas.aw erNs�
enwn aS Dan 0 Natural 0 HaWid: e 0 AcodM 0 Pending IMntgaton )
0
0 weea7•=m wen-.a pm Ter rat sae.tar 0 kivc seesWe'eree n. aid. 0 emee 0 Cased Na Be erermirec
34. Date Ot I.'yvtry(Matt/Dey/Yeay 35.Time Of Injury 36. Place Of I:yiry(E C.Decedents Home,Constitution Site,Resxuam Wooded Areal 37. Puy At Work? J
❑Yes ❑No I R
l
3<. Locaun Ot Innury-Sax 3Ea. Coy Or Town 380. Sew C.Number 38c. AS No. 38d.Zip Cade aa1t
] l
3G. Describe Hai Ir ury Occurred 0. If Transporaoat LWY.epy J
Dt.ec ee QeakP ate .an Onor hoot)
i
- at Signature,a Perm Cef fyi g Cause Of Deady 42.Center(Check Only One)
TERRY GEHLHAUSEN , BY ELECTRONIC SIGNATURE 0 Cer_yilg Physician 0 Coroner ,0 HeC=v`.� e
1 43. Name.Address And Zip Code Of Person Cert?yeg Cathie Co Death: 44. License Number 45. Dew Ceres
TERRY GEHLHAUSEN , 1020 W. MORTON.OAKLAND CITY, IN 47660 02000730A 12/29/2018 li
46-Add.Xnal Funeral Service Pldvider. I 47- 'Akae: ve
re
4Z. Signature of Local Heath - 49. For Register Only -Date Flea (MmlNDayrYea): I 4
a I Once
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE I DEC 31 2018 I D
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) ..
•
a(Q-`-3e" A - - oco. 3u -csoS
I ,
r State Form 53395 ATTENTION ESTATE:The Social Sewmy abeing
is requested by this state agency in order to pursue responsibility. Disclosure is voluntary and mere will be no penalty for refusal J
• UME
WARNING: miEN5 ROMORA• GE TO S ELLOW VMLON R BD ORIGGI AL DOCON UMEN AL)HHAS ASHIDDEN VOID FROD THTHE AT APPSEARSOYI EN HOTOCOPIEDE STATE OF I4N4 ON BACKTHAT y