Death Certificate - Scott, Aaron E_5/9/2019 �^y FeltW INDIANA STATE DEPfTMENT-OF HEALTH- '
i1 y �'`t`� CERTIFICAT QNDEATH p
' L'No 000135 EDR No 0000005'84981 State No 031663
I.bastes Legal Name(First MMae,tart) 1a.MabnHnsiie'lt female) 2 Sex 3. Tin Of Death 4�hDate Of Dann(M«tVDayWar)
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AARON EDWARD SCOTT dC % .MAL•EI' 03:50 AM 06/23/2017
5.Snit Security Number ea. Age-Yrs BE. Uma hY'w;Les unbar 1 mow, ea. Under 1 Day ire. Under 1 Hair T.
GIBSON COUNTY, IN .'
9. Eva n U.S.Armed Faces? , 10.t Death Ocvnedln A Hospeat ..10a,II Death Occurred Somewhere Other Than A Hmpts ' s
1,"(yy EC§ ' 'Hospre Fealty ❑Decedents Ham 0 Nursing Hn bm&ap Ear
t9 YeeO'Hoitapnlew.'n ®bptea 0 Emergency Dece t ere Ouptad 0 Dead en3eLY WI 0 Other(Spedfy) �l; ) -
It.FaflSy Nana'Of Not Instructs Give Street and Number) Vy.y�tiN' two.yre
GIBSON'GENERAL HOSPITAL n. re"' .was.
12.Ca"Or Town,Starts,And TN Cede 13.Carty 14. MartA Status Nrme Of Dean a�t1
��1 �,� 0 Mated 0 Meted,ad swa need..O.Div�imea
PRINCETON,IN,.47670 14lfl ' GIBSOthV O Weed 0 Naver_Manied aOyleewtn '
15.SUMag Spare's Name :LSe -' 15a.last Name Before First Maneper 'elm 18. Dsuda¢s Usual Captor 17.)Gt 01Sits Osry
g�a, �A ',
a.FRAN ES M SCOTT - SCALES' INVESTIGATOR POLICE DEPT •
18:,Rmsa�m-Stare lea_Carty AV., Ob. City Or Torn 41fi<1LIA
NDIANA an, GIBSON PRINCETON a '
tec Street Ard Hunter `V 18a Apt No_ lee. Zipd Ca 1&. radar Orytinbt
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201 SOUTH PRINCELSTREET a�64 308 47670 .SL6n9 0 No q
19e0emden[s Edrxatrdn +, 2. D. Dead Of Hiapsic Ongn s'1L6-21.Decedents Race ��(a,.
r .Iv 1q-C�' �vLL�� �� 'tom/v .
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p'ASSOCIATE DEGREE(AA,AS) NOT HISPANIC White ..-.s
.I D.Parent's Name(Fest,Mute,Last) vA@- D.Paean Nam(Fist Middle.Last) Y'`� 23a Parents Last Nara Belem Ent Manage .
SAMUEL E SCOTT :Sat. ' GLADYS B SCOTT MINNIS m4 •
24.informant's Name , 24a Reltontip To Decedent 24a m rda Maim;Agates(Steer And Nu .Cay,State.Zip Code) 4T17
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GAYLE COCHRAN ANSI ' DAUGHTER 502 SOUTHHSTORMONT STREET, PRINCETON, IN 47670
- r2>.Q:'' 25.Race Of Dis ,2i'."> fa*S ">
25a Method Of Ouppsieen 'WA 25O Race Of Disposi5on(Nam OtCambry,Crematory,Ober Ram) 25c twear-Qty.Tomi,And State
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®asW O iem.mn 0 Onion 0 Entombment s�. ylily
❑�emwal4 Rom Seat .ate#t\' �.
noediNeeedtyc DECKER CEMETERY PATOKA, IN ,r` e
Dr Was Conner CoraoadT ;TarNama CompleteMtam Ads OF-F,usal Facility
1�,r� 'Mir Va. Fulani HareL nor Nunita.
IDYes ®No ._t COLVIN FUNERAL HOME INC,425 N MAIN ST., PRINCETON, IN 47670 • FH8300567,1'a
22R Sq'atn Of Islas Funeral Saviet3m asa: fit,`\%OJ' 22e License Number(Of Uterine): �r\�►
MARK R.WALTER•EBNgELECTRONIC SIGNATURE -.. FD01013010_. ink91
y,itit:i der A"•et Of Death (See lnsbuefipns And Examples) ....Din; ITT" Apprmamte
tit429:Part I.Enter The Chath Of Evert; -Diseases.hippies.Or Canplcadots-:Thal Directly Caused The Death.Do Not Enter Terminal Events t Intarat Onset
\Strii As Cardiac Anent,Raspuatory Hest,Or Verbic Fibrillation Wp2�h&t Shaving The Etioigy.Do Not Abbreviate.Enter Orgy One Case On � To Death
o A Lim. Add Additional firm t Necessary. ) yef
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L-umdete Cause(Fire(Disease Or Resulting In Death A PNEUMONIA � i 1 WEEK
11' 1t«YeCaW�u ri Ky�, y�
AR Wi!I =R..'enaY
gagman*List con:wenn. t myeteatltrgiTO The Cause listed On B. CHRONIC OBSTRUCTIVE PULMONARY DISEASE vm 20 YEAR✓lL'
Line A Enter The Underlying Cause(Disease Or Injury net Inhaled - �L..nr A
The Everts Resulting In Death)Li tIEt C. STROKE LA.1I:CnY .5 .
t&hlr y7{F� „no ore s tor..At ea al -,AD
_^lit%y1= D.Q URO COGNrnvE DISORDER ha 2 YEARS
Patt Filer Other 58785211212120211.112.1)13893 But Na Resti1ng InyTMyt4baynp Cause Given In Pat I 29.Was An AMspsy Podame�dNt j 0 Yes 0 No
CP
DEPRESSION - MPcS 30.',We Autopsy Farling Avert To Complete The Cause Of Death? Yes 0
No
31. Pd Tobaorp UNCaWLae To NC? �, >Z. Its mai:
33. Marna Of Dent ���
R1w�3 ❑wear. se rrr 0 P�.0 «sm 0 a wee « ao n ®NaorN 0Homicide 0 Aoddea ❑Pad�ig@�trT3wstiBaeo
❑Yen ❑Pmbty®No 0u�aa�' 0w:thwart,e4 Nae's CO ,Tel re e.ar.o. ' 0 rmw.'empe5erre Th.P..v ❑Stidde O Cored Not Be Debnnned .In.%G
34.Das CI nay(MmttVay?Dy¶1) 33.Tree et Injury I 38:Plasm Oft/try(E.G.,Decedents Home,Cmstnnion Ste.Rests-rant YAwded Area) 3a29118tart Weir
0 ��li
{ 12.411 w�1"1� Q�1� Cdtrea 0 No
"Lncatm 011rjtry-StYa sea Cuy Or Town 1'i 38b. Street&Nlnwr, �` Sac Apt.No. 30d Zip Code
as. Describe Hoar Wen oaeeeRik
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OW Bill To..eran rr irntir..alan Omea'ei1 <ry�3rV .
41.Signalise Of Pont Cartyig Cause OF Dentt {{gi�p- :y 42.Certifier(Clads Only One) mid' '
KRISHNA MURTHY, BY ELECTRONIC SIGNATURE --- _Uittl44 0 Candying Ple+dai O Cams O HeCuafter/ .
43. Hann Maass Am bp Cot 01 Posen Cetfyg Case Of Deagc �yTV� ��L\ - 44. License No:ter 45. D eCCa Led
KRISHNA`�MURTHY ,685 VAIL STREET, PRINCET`O�NN N.r47670 Vl .011w0yy3�188�888AAIW 06262017
s483 Adatrena Funeral Savlm Pr, 'aKga,,l''O 1 1118'
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48'Slplmva of Local Harm Meer. '�'/�. `4'M" V, 49. For Registrar ONy'-Deb F9ed(MaeWryyyml
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE . ,�.t 5 - JUN 27 2017 ...h.r.'n .
E8�/)rti- AMENDMENT TO CERTIFICATE OF DEATN_(ENTRY OR ORIGINAL) _CT.-L " •
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State Form 53395 .ATTENTION ESTATE-Ube So ill Stagily a di ;guested by this state agency n order toy wrespomlbdily. Di5C14'% Lary and there will be no penalty Fir ref o��11
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WARNING: TUR.Y FROM ORANGE TO YAE IOW VHET RD BABEDGORG NAL!TALON
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FILE
MAY 0 9 Z019
GIB
SON COUNTYUDITOR
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24-03 -RS-02cn -rev. 1,32 -0/8