Death Certificate - Feathers, Donnie G_4/25/2019 ` INDIANA STATE DEPARTMENT OF HEALTH ▪ --��
i9 . CERTIFICATEi(iFDEATH
Local No 000169 EDR ND 000000655995 state No 036520< .; • 0 fg 15
1.Decedents Legal Name FaX MIS Me Lase la,Main Namara fernae) 2 Sex 3.Tare Of Dear I a Date Of Death?5cetotay'eEe
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;� DONNIE G FEATHERS .MALE 08:30 PM 0720/2018 y Z Soot Sea.my NLrmbe Ca.Age-Yrs es,Under:Yes l Sc Under:Month St Under I Day re.Unar;Hos 17. Dare of Bit;(M._N.Y/'ra) 8.@Tplra(Cry as Sat«Fee"rn Carer
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Fess? 12 It Death Occa:ed Ln A Hasaa2 a IIDeat.Ccnced Someance Dais T A•septa rr
R:'F. ❑Ho 4oe Fealty ❑Decedents Has Cl Nursing HereAmg-term Care Featly L'
®Yes 0)Yo i0 lin:.mowl ®treater 0 Emergency Deemer Orr en: 0 Deed op AY.vsI 0 Other(sorry) .' `
Ti.F.�y Nat.of Nebr.-as.Give Saxe end N' 1.:•.
GIBBON GENERAL HOSPITAL 'r j T
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12 Cry Or Town Sass And Zr...Code
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:3.Cana Of flesh ,a. Marra)Sr=A:Tme O:Dee:.
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PRINCETON,IN,47670 GIBSON r! r 71 oose< 0 Ne erManteo Meatiacr0 Married,But D Misted '-
l:` Is.$Wrong spoesee Na.. ❑King Of and s dusoy a
:Sa Les Name Before Firs metres �.i - i6.Decedents Usual OmeaSon 17.Kind b 0rs:a_s'Itdes'jY
a BEVERLY J.FEATHERS BUCKNER a PIPEFITTER • - INDUSTRIAL
!� 19.Resdece-sae IBa Cary le,.Cie OrTwn
') INDIANA 'GIBSON PATOKA
1 Tec Sa Ard Nauss 1 ..Ant No. n ' lee.Zp Cab •St.L.r L Day ees?
: 6347 WEST 450 NORTH 47666 .0 Yes ®No
1 19.Decedents Dents xC De Of res ,ic T3 Oman - - • 2Decedents1. Dents Rem .. -
9TH-12TH GRADE; NO DIPLOMA NOT HISPANIC White -
'‘S. 22 Pareofa Name(Fat.Mike.Lase M.Parrs Nana(First Middle Lase 23a.Perm Last Name Beres First Marriage r1
1 EARL FEATHERS ALVAGENE FEATHERS '
RIGGI NS
24.I.Jar ¢s Nara 24a P,tlffiass:id To Decades 24G Mang Adde.ss(Street AM Mender Can SSe.ra Code)
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SUSAN SECHREST t DAUGHTER f 4952 WESTiCOUN Y ROAD 250 NORTH, FULTON,IN 47023
.. I 25.?lard Of
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Ds rots .
.25a Mated Ofaase 25b.Race Of D'spabon(Na:eO:Certary.Cressy.CM-Pea) 25c Lent:0-City.Tor,And Sate Bmal El Carersen 0 D«azn 0 Ersmr Ramanmsax
a ❑Cher(syeci: EVANSVILLE'CREMATO RY EVANSVILLE,IN
FIL• 26-Yas CggerC« = ! 27.Name PId Ca-plea Address Of Funeral Fade.), IF��Home License Number
❑Yes ®No
COLVIN FUNERAL HOME INC,425 N MAIN ST., PRINCETON,IN 47570 _ I FH83005671
- 27b.Signs"Of Sara F'_.eel Serves Lessee _ D
MARK R.WALTER. BY ELECTRONIC SIGNATURE S F. FDtc-O 0 3010ir 11 /+ INws5 LU I J -'
Cause Of Death (See thsauc3uns And Etampla5) i Appreunate
28.Par.I.EaThe San lY Event-Dseases.Ir>;mies,Or Complications-The Meath'Caused The Dett Do Not Enter Ten-neat Every Irdnt Onset
SuchAs C Aac te Rao' «yrs,Or Vercintar Fanlaiol VkhpASMr gTne EtiAogy.Do;_:.:brttu:s Enter OnY One Cause O: n To Death ALinG. Add Atd ',te tires If Necessary.
_ `J/NJ'V(!,^Y/atae-s�•/esel^.Y`
Ltnedat Cause(F irl Disease Or Casten Retest;L Death) A. ACUTE ABDOMEN.UNSPECIFIED .TGRO
an tone uev,.
d I v
r' semnn'Ent List Cuts, Y.Any.Leaning To The Cause Listed On e- HEMATEf.IESIS - • -
L-meA Enter The Underlying Cause(Disease Or friary T Instated
-; wnm.r.rae.e�aa :WEEX
Ic' the C.eias Re tare hDea)tag T
fP C. HIP ARTHROPLASTY l. . t 'e V.F▪FYS
F - t, cee age raresoary oe ..
D.
` Pr IL Eisa-OteSat,Oon,:-aaCc:r_iS:.np Deity Su Not Rest-ng In The Und>tryg Cause Given In.Parr I '29.'Wes An Aupasy Pe-fame-0 Yes $No
0
'i DEBIl1TY 1 X.':.tee As-spry-nd-x Astable To Carpere The Cause b Dear? .[]Yes 0 No -
31.Do:pba®UseC a oDes.? U.V Fria n. 3�J Manner Of Deim' .
0 Yes 0 RrYaYy I]No &Urcroxn I 0 maetss•e-,esse 0 ev«ea- 0 Herne' ae Ta eva�,C OarsSS= Z Nraal 0 Hr..ode 0 Arden: 0 Pe+r yll span
❑r.aa.+-e,a:aa•u:armr ar aerie p ue.t-an.ama.enn....a..r ❑S cle 0 mid Na Be De`s-:ed . 1 'e f.
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34.Da Of Injury(Mcit .Da Pear) 135.Tee Of lra+ 36.Plane Of L(yEG,Decedents_Hone,C«`rsct Ste.Rssrent%base Arse) ISIP LTry A l'Sine?
j 38.Lmm CI lrym -9af39.Describe e !Nay . h� r
35a Cya Tam I.'j 35. Sear S\ynbe i ❑Yes ❑No
38c Apt No. 39c Le Code
Q.I`Ttxpu❑on lnA .�reify:n, 1
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G at.Strafe.Of Perm:rie'-y-g Came O("J9R, I_
�' IMICHELLE LEESNTUER:BY ELECTRONIC SIGNATURE I a®ceryingpr¢itmr, one) Carver ❑ve 0e ' i
1' S.Name.Address Ana L;C Cede Of Patton CertNng Casa b pi : u. LFcts¢.Yc^Nr t- Dar Orr-ad
• 4 2
MICHELLE LEE SNYDER . PO BOX 9 328 N 2 ND ST,SUITE 102,VINCENNES,IN 47591 02001984A ( 07/26/2018
] I ad`Ada mal Fs--al e Scam Provider _ - - a7.A'A:aa
yb eras.Sie r Ces(Hea^.Comte. - 'r.;r, se For Repxlnl Only a-Das Fled(M«LVOSrrceal: `
L. BRUCE BRINK JR.VA ELECTRONIC SIGNATURE or:.•'..' JUL 26 2018 .1
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) v
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1 State Pus 53395 ATTENTION ESTATE:The Social Seaway A a beng req eeec by this tee age i n,order lb piasua raspo.s'be_y. Oscosire is volmary Pena`/ �aJ.
a OTURNSAL OOCU rTO A µIhTICO!ORED BACKGROUND ON SPECIAL.HA�E HIDDENY PAPER AND THE GREAT EAR OF THE STAT_OF 4'.DLS`lA ON:?C;{THAT
WARNING: MANS FARM GRANGE TO YELLOW WHEN RUBBED.ORIGINAL DOCAAIET.T.:i15 AHIDDEN VOID QN FRONT THAT APPEARS Vf.-:EN PHO 1s, OF ED. :t
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