Death Certificate - Young, Barbara_3/13/2019 "Y/` � r INDIANA STATE ARTIGIEN 10 9 2 5 0 8
11 �.
�. , CERTIFICATE OF DEATH
. „2,-: Local No 000064 EDR No 000000378282 State No
i
1,ree'ede-itY Legal Name(Fast.Middle.Last) tat Maiden Name (if female) 2 Sex 3.Time Of Death 4.Date Of Death(MCnL'JOaylYear)
BARBARA J YOUNG COLE FEMALE 10:45 AM 04/03/2014
£. Social c....Ly Number 6a.Age-Yrs 6b.Under 1 Year 6c,Under I Month 60. Under 1 Dry 6e.Under 1 Han 7. Date
Forces? 10.If Dear Occurred In A Hosciut 10a. tl Death Occurred Somewhere Other Than A Hospital
❑Hawk.Facility 0 Decedent's Home 0 Nursing H e&ang-term Care Fadfry
0 Yes 0 No ❑Unknown 0 Inpatient 0 Emergency Department Oupadern 0 Dead on Arrival 0 other(Specify)
11.FacLty Name(If Not Inclusion,GNe Street and Number)
500 SOUTH CENTER STREET
12.City Or Town,State,And Zip Code 13.County Of Death 14. Marital Stites Al Time Of Death
®Married Q Monied,But Separated ❑Divorced
FRANCISCO, IN,47649 GIBSON 0 Widowed 0 Never Marred 0 Unknown
15.Surewc Spouse's Name 15a.(If W:e)Glve Malden Last Name 16. Decedent's Usual Occupation 17.Kind Of BusvteWrdusdy
LYLE YOUNG HOMEMAKER HOME
16.Rrnk lm-State 18a. County 160. City Or Town
INDIANA GIBSON FRANCISCO
18c. Sweet And Number led.Apt.No. lee. Zip Code 182. Inside City Lents?
500 SOUTH CENTER STREET 47649 0 Yes 0 No
19.Decedents Education 20. Decedent Of Hispanic Origin 21. Decedents Ram
9TH- 12TH GRADE;NO DIPLOMA NOT HISPANIC White
22.Fathers Name(First Fiddle.Last) 23.Mothers Name(First.Middle,Last) 23a Mothers Maiden Last Marne
DEVON COLE MARIE HOPE COLE
24.Informants Name 24a.Relationship To Decedent 24b.Madng Address(Street And Number,Coy.State.Zip Code)
LYLE YOUNG HUSBAND 500 SOUTH CENTER STREET, FRANCISCO, IN 47649
25.Place Of Disaoai'in
25a.Method Of Dispositon 25b.Place Of Disposlien (Name Of Cemetery.Crematory.Other Place) 25c.Location-City,Town,And State
0 Biral 0 Cremnon 0 Decagon 0 Entombment
Removal From State
❑Other(Specifyk FRANCISCO CEMTERY FRANCISCO, IN
26.Was Canner Contacted? 27. Name And Compete Address Of Fueral Molly 27a. Fungal Plane License Number.
0 Yes 0 No COLVIN FUNERAL HOME INC,425 N MAIN ST., PRINCETON, IN 47670 FH83005671
27o. Sgnabre Of Indiana Funeral Service Licensee: 27c.License Number(Of Lice:meek
MARK R.WALTER, BY ELECTRONIC SIGNATURE FD01013010
Cause Of Death (See Instructions And Examples) Approdmate
25.Part I Enter The Chain Of Evenly -Diseases.Injuries,Or Complications-That D'ccSy Caused The Death.Do Not Enter Terminal Even Lnterval: Onset
Such AS Carla:Arrest,Respiratory Arrest Or Vermicular Rhaetian WithoutShaking The Etiology.Do Not Abbreviate.Enter Only One Ca�n To Death
A Line. Add Addtinal Lines if Necessary.
Immediate Cause(Final Disease Or Condition Resulting In Death) A METASTATIC RECTAL CANCER 14 MONTHS
li-.le to A.A ca.t.-os
Sequentially List Conditions. If MAR Any,Leading To The Cause Listed On B. Duo A.A r wwww.orr 1 3 7019
Line A. Enter The Underlying Cause(Disease Or injury That Initiated
The Events Resutb g In Deem)Last C.
• u1b4A few.s V; v
D. W
Pat U.Enter Other$isnYant Ccnditions_CAcabgtno to Death But Not Resetting In The Undenykq Cause Ginn In Pan I 29.Was An Auelg3elld(r`OU 1Y3 NjUi t
O
30.Were Autopsy FNdl g Avaiabe To Comdata The Cause Of Death? Q Yes 0 No
31. Dic idbacm Use Cattioee To Death? 32. If Female: 33 Manner Of Deem:
Q sz P,e..wwer°whiz Q P,w..0uFF.teo.. Q wP,n w wi
et s4 Fur.", 12 Din ao.... 0 Nagai AccidentEl Homicide 0 Q Pending Invest/eaten
❑Yes Q Probably®No ❑Unknown
0SuFml.AewP,.e.wa0.0r.t,...e.r.D..ee ❑ er..w.+wa..11.°.wv. ❑Suicide 0 Could Not BeDetermined
34. Date Of Lryury(Mm:NDayiYear) 35.Time Of Injury 36. Pace Ot Injury(E.G..Decedents Hone.Construction Site.Restaurant.Wooded Area) 37.INtay At Wok?
❑Yes 0 No
38.Location Of Injuy-State 38a. City Or Tam 38b.Street 6 Nu.mbes 38c Apt No. 38d. Zp Code
39.Describe Mow lnprryOmrred Qa I,fr Trrm..s.va0on�lnpea.Y.a t-y-
Qaeie
a1. Signature,Of Person Certn g Cause Of Death: - 42.Certifier(Check Only One)
CHRISTOPHER BRADEN ,BY ELECTRONIC SIGNATURE - 0 Cartil)+na Physldan 0 Coroner Q H°ae'o5cc
43.Name.Address And Zip Code Of Person Cereyi g Cause Of Death: . . 44.License Number 45. Date Cabbed
CHRISTOPHER BRADEN ,4055 GATEWAY BLVD, NEWBURGL; IN-4T630- 02003326A 04/09/2014
46. Additional Funeral Savior Pro ter J '- 47.*Aka
48. SIontire of Local Health Otecer. 49. For Registrar Only -Data Fled(MondMDay/Yeart
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE - APR 09 2014
AMENDMENT 17)CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
r..,. , s _z_p _ I0, ,,o0 134 - no•r-
,k3 __2.0 -l03 -00 0 • 3 3 g - 0 OS'
State cam 53395 ATTENTION ESTATE:The Social Security It is being requested by this state agency In order to pursue resparsibity. Disclosure is voluntary and there will be no penalty for refusal.
IVRA-20
(WOE)
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