Death_Certificate Simmons Fv�E' ` a e .�-$tt f �*` "art i.. • _• '�,asY,.. a . -e _ ,�._,.i>Y
aTtEHtwtt6t.L 1raSa°turtt:y is FILED
•A Tg ATTENTION
Pry ATE sThe Social
in ordea is
,� C t ere 51be no pen 01c us INDIANA STATE DEPARTMENT OF HEALTH
`. =a7and
tbero Wnbe royty itrrMM.
s-" _acal No ,. j • CERTIFICATE OF DEATH State No.
�� /1.Tc JAN 2 3 2019
• THE RECORDS N THIS SPEWS ARE COAffIOEhML PER IC 1aa7-1-1D
. PRINT 1.OalY .e Crest T D-NAM LW . 2 SD A. nee OF CIEMI a DATE OF OF DEATH a Oa ,
Ivan Heber Simmons Sr. - Male 01:25 AM., .1' uary 13 20
O -N m'1. SiAGE-tat I th y 50 UNCEA I YEAR Sc UNDER I DAY
AUS VCCADOII w'Unon SAfl0 W YI4R f- 04ne coon sA...a...r.v.1
D n Z US v[TnUH, US WED FORCES/ HOSPITAL ❑Wan ail6! m
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2 No MA ❑ERIOar'e Does I— O Noarq Mono ❑are:,(Sped,/
SSE; b FACLnYNACU a.Hos-- 6,4,Yat xCItt,TOM..ONLOCUiION OF CLAN Id COUNTY OF DEATH
_� J NT Gibson General Hospital SNF Princeton Gibson
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--0 to WRTAL STATUS II.SVJVNNO SPOUSE!,-. ' lia,ofCECOMS USUAL OCCUPATION(Coo by ofMO.at IA O OF SIS SS/Np(ISTRY
(sP/I+ uw.va.aF1.•,r.I . •� -.m,.Pl..v rani nalwat ht•DAiv,emast)Q` Z Married Lunolia Augusta Vot n Meat Packing
rl H O 134 RESDEN•` STATE ID COONTY PEP CITY.TOWN.OR LOCATION Il!STREET APO HUMS
/'\ 0 0 m IN Gibson Princeton I 608 N.Gibson St.
L• .I mna ) e,}Ii}:UCAL-'E In A.OE CITY MATS 14 0mm OF Is WAS DECEDENT OF ILSaAJC ORGII IS RACE-Nona Iran, IL MODEMS EA.CATCN
\1l �y ' / One p Yin wwr<QMTRY, $era ❑... ay.I facet,Cobol atl Moo et (Speer et*WOO lbaenFnth
U.S.A. • mem.Ryall'ne,
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�ITI>•• .I Is c1 rreas NAIE Ver.:JeE.EIS Is MOTr1Ees NAME(lea Abaft Modn Smoot
J o cd o L,H:ber Simmons ' Edith Alvis
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m ,es ENT n tfOIWsNTS Nibs('ea.mad MI mue6 AcoestSam ne/+.Ttht' a Raw Me.,C. r..,san la Coto ]R R:a_a..e
-.O Liinnolia A. Simmons 608 N.Gibson St.,Princeton.IN 47670 Wife
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r . O Z•, 2Ii 14OO OF OISPOS:ION 0 c ...... it>DATE APO RACE OF DISPOSITION(Na".dcn.v>canary ee Ste LOCATION-CA,et Town Sys'Ci>i Mews TO C'_ 0 Pa,a.d Int,se a,wow.) Jan 18.2007
-c—. / , P.�---v d'otacme Sand Hill Cemetery Princeton IN
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- C> TIONr•.]ia E.ICUERS NM4 . SA EICALaERS LICENSE NO is WAS CEA'.FEaLTRTW TO rani
c m Richard D Hickrod FD01012153. . r•VN^
Inc _ _. .
rnm is SICHATV4 OF F;NEML°RECTO1 - E.> LICENSE where ANA.E omens AND,g1.,c-.SNEER OF RRERAL POE
to II adk�l
w Z • Colvin Funeral Home,Inc. FH83005671
m > "Wt' 'Lit i 99. /r• ._:_/o_n czs/ •-- FD01012153 425 North Main Street,Princeton,IN 47670-
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m o Ramesh Patel MI) 105 N.2nd Ace_Princeton,IN 47670-
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wJURY OCCURCD
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r V010 IF ALTERED.OR ERASED-NOT VALID UNLESS.CERTIFIED BY HEALTH DEPARTMEN