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Death Certificate - Martin, Raymond V_5/8/2019
-wc -sA -,Ww,-C -si•. y ..a.rPl/a .-ir .mow 'W _ _ .� �C�""off% v �� 1� � 1' ` �INDIAN_A STATE DEPARTMENT OF HEALTH \' �\D�\- ��V �% ' �� i , 1 � 1 , "�1�`W) j[`,_�,e I�CERTIFICAITE OF DEATHirt IR, . y, `I i. I `•n�Local ND D.00477 1.,..-", EDR 0000006541,9'0 !' i?�'sta 161.81 M is,,..:e2.-1; ;,.4 �Decedent's Legal name^vsy Nmlfe;Lasgr 1 !.). [z?i‘I �Jl i r 1a..MaMen Name Dl female)i '/ }�J[�1I z:se,vri 3.. .n•, e.l Da:.of Dean p.+�relwayrcear)�. �,IUD ,..//. ,11r /.dlk li 2 1a,rF�„ , ,` _IG �6--tz 1 IGF.\'��r'1 it ,`,.---A, `�;�y IIIIII� p1�1,,.+RAYMONDV.MARTIN� `` I t L li 03AM\ ardSmt.C°0_7`/12/20_t-8' k:5,Soral Seamy Number :6a Ape,Yrs�.oe UtdertYear Bic UMn t MMh-6d.1aUMer_1 Day/ fie:,Undesl Hon::].:Date Mt earn.: 6-Bi• !(Guyana Staten Foreign Counsyq� t- I .� v is ii nt � t r v i n�cs--/nw `� �/�]11� I z z - r / ry fit is f,,, ~42 //� 1[t � i1 FRANC tl llf +¶per ,�¢' �1 F%3160 > < �\�''1\��I ��\��L \�s1\> ��•`�avl'f,` Q t ❑MoiFice Fa�y� 0 Demcere Hama 0 Nu�'rscp•�� eaY � ^ 1.❑' Yes °J NDl❑Unkarewn ©'Inptie,A EmerpaCriiranment OutpabeN ❑Deadon rdval ❑ rrir YW lrli F`i ' `Q£`1 a i 5 m 11f1ss1 F butt utinlet and untie.)!/In�lTff�/J/aslt nvC/ '6• PM _ I� ILITY"/�� '1[ �1Hi'q �, i 1tl Faoby Nametpf Na Instt Give Street and Number�v a iry 1n 4 11 fl I DEACONESS GATEWAY,ti; .� 7.-- �G"> 113 1'Iln.•�c. �� r� .. .. / , , `t (• - n k.- 12:-Cary Q.Tow n,•Stzte;And z p Coale \ v \�� U 13h Cony 01 Deat'a 4 s. 04:Mama)Six Al Time 0f DeaT ‘ q� ttl v �t--/ ' 1 � 1 P ' N° ,1 1 \�BSYr i[cTro �.LD�� .. o'yam �1 (� i1y t /�] . �� ��` �j tr ® amen❑Monied&n arrest uvaaa , NEWBURGH,.IN,47630>�.' �✓/7... tI�III {3 11T{ `r/f 1 I\i WARRICK• !/ ,ULl �llllf'\{G�O p^ed Oi wawa OI?Tht 4 15 Saviwq Spaces Name [rJ y, �Y\\-,... ii �,15a tanva 8Bel Feat Marriage _r.A U.Deceamts Us IOca aem t]!Ke Of BuoelesMndustry \ I+\a ;Cs.. 1� n rAl�- II1V� .yt.\���jl� /tp1 � I w�,.itil r! li �1_1 1\\. ^1 PHYll1SMARTIN i11l :id...{1ttnt.e% ..{i1L• .4KRAMER ,i1_ G-241110i'Ver till GAS.STATIONOWNER AUTO P,RO, �//� 1' yB�•tResidenca-Sute ( I -IBa•Ccny Ti ,s ! ,`..-a16b,Cry Or Town' P+' R• ;a -y 5. l/ � � '- � n 1 / t tIG� �! .1X1 �y fC -. Q is ,,tf 0. INDIANA \ GIBS ON-h"..-d L,;;\ HHA`BST D. za.,\\`h n� tSc%Street An N mmbbbeer,' j;�{��pT✓�. ,I. - // 11'� v�///� r&'- 1 '� &' /. sGJJJ���}}}i .18/d1Apt No�— 'Wall <tat IvEe City Lmu7A eetAndN//���11111C'W�t y� l/ ,./ �1t�� �41�``,11,II - i ff{R/ \\i/®pYe ❑1N��/� 521aSOUTH 9TH AVENUE tSi\\\I ���. UlV -1,7- `U�k Utk �. ��d� 47,6391�: .:\\\41111 a Demdenrs Equra ^ `L-`�:i1i\`�� 20. Decedent Of Hispanic Odor" \� ._'l .21.DeceaenrsR a V - - mil % v a I (1 1�� t. l � �O i\� �L S HIH�SCHOOL GRADUATE;ORrGEDp//oi{I1��1� � � ,'� � „� �(�p ��11(�� ` COMPLETEDittlU/�ilh[I[l%/JkUtUhG NOTIHISPANIC1;1���111%/�lI\1 White!l\il[tfi� l[,I 1.11(t ��1[113\�.1111111� ' '; 22P2rIT Name nt MiE6e;lazt 1 Wir ( U� ne-. erCS.. (F:Si to lasU ,i tit' V ,( G z3ar Parer - Nat C Fast MamapeS'i, VICTOR\M\ 7;[1 .a �?:-r-A(In• /�31 i/1 A LI LI N MART 11[l�% tiN,, As IRE eK'11( O�I1�,�6r+'-•f/�' °l il/fail[{[1[�Itwcyr.I -- t //tt�ll/l l/ 1 niit �UItllUjanesk�.'f lUll[1:a/cC\Sill,Ces. :JUU t�F�'lk, /�� I t& G' G' vl trcd U 0U \ P,HYLLIS:MARTIN\I[Fq'4u > > SPOUSE \ 521sSOUTH 9TWAVENUEIHAUBSTADT- IN-47639a .< i 118"%n71Ln\\�7/1.. ''-.v%/_Il.cr X/_t1t�\vn ri•.Y/_li571:; ceODuoc:;ao,.-z//lI LM.`v- iin\'^ Z (\ 'Y�11nf"//1.. '�'//laT1- % 2SaMefado spo:.o,// [1I1i1S`%//f111t11125b:RaceOfcesposison(Ny eofceeemmetery Gems/ofry.Ocie Place, zx2Loran,VCny,Toen And St. II". 1� ®R`uril❑Keel EirK aoon o:En611,2 11 %.... t/I 1/�////] II 1. t v 1}{{�/:TA 1!t ,.. li ` U , .5..1. ❑1iT°'<-�Sta:e� 1 �K\\\ Y 1„:!"CUB M3�d� ll \\ `�.s •`z O 11 �� k 0 oreaspery s&Z%/.5(; i_ HOLY•CROSS CEMETERY. /&I ks/J(11n FORT_BRANCH9IN •':-s/J.6� /1_tl� R\� — ) 126 Was Coroner Contaceai 0/ 27-Name And Complete Address Of Finial Facly // // 11J 1 I[II� 1• 1 / G;ail Frner<IVme Licence Numberi I ���ll"t\11 ��� / ?h'r,' s ISI\Irr4,111111'illa0 �� rt 4% 116 lq, �1��1 uu,t ;l 1 'ft❑Yea.©No I "\�\,ur � STODGHILL.F.UNERAL`.HOME.INC.500 E PARK'ST HWYc168,,FORT.BRANCENN�47648� �1FH10900013r�_ '2]b1Sipneue Of,tedana Funeral Service Licensee:\\. %/II ni`n-'//lt1t�f/tI n�� y'71 - rn •nrLicense Numb(OfUsensee):rLC s,iv T . lIN€' ¢ANDRE�A/LYNNrST'O/DGHILL!BYdELECTRONIC'SIGNATURE`//�Ii1if n -9 hrn if� FD2n1400005 '' Af[[1[(tit� lilt fiC%-111n1ft S N n' 1"�/ [ ry `,ease Of Death (See Instructions And Esamples) 7 \ i he venl��/�lesslll;�i��itmplcaoon I.,><« et utDt , is r .� 11 Aperval: tQj s28Pan) Edi ThefnamspFtoey tDiseasesesieues,Orill l .tou-Ttut g-The Causetl we of Abi Not.Entt,,OWnalEvents" ?, O Interval Onset) • tsn3i A's Cartlac MesL'Respea ory Artest,�Or Ve�rcrirL4lai FiMllaum WlNdtn Stowvg�TheEtiGo°y�1DrO Not Atibenate-E�n:m�OnF%OIinV(e�{G�e�usa On �4` :/1/���1(`1 %/����111,(1L,(((LLl To D{'le1,raL'f�`� 1 rALne. Add Add tiw al Lies M Necessary j �I 1l1�� \'ll([��1'\\A- v/\11 \L:;' t\hid. // {tll�tl%/111 le:I a %tlAdd nutn //es1nnl "�nr7, I n 1,ai /� I`l { lG 1 <4cmedtl au�(Fnal ern%Or�C��- 4. n ResWxnpU 6--)\�\\tql `A114-1.r\\TIC\S{H1ULO�C�/K�\\�\\��{{1i1��>�V \\ , /�� y/�D��AY�S� 1 y st tl 11 ''r _I. 8.4e.E.HYPO%IC RESPIRATORY FAILURE,-.- oeeie \\�\n`\\\�7Sr �l D\ g\S ' ✓ Sequent aM List Conditions If Any,Leadeg TO The Cause listed On/ _ / w.alo-..acwaas.oo� / /i Lne AiEnel The UntleknoWise(Drsease Or Inpay Ttia�Initutetl� i{ci �{n1 f/ Q, i rim I L14 rim 1 .//. u l/ I'�.��tt. / C\�m �ae:y yi1��,lad'1r/%ltlllj}1U�11�"`fi /�e4)t- 11-- \1\\\%i.o 11 l-bill, �\\���11� `11�1( vUI IPar:II Enter Oiler Scrtr$irne�SCLa�nU t Condcions JContntlo to Death But Not Reess/Llsng In DTnie UndMavq Cause Given In Part lr 29.tWas An Autopsy PMamed'1 7 `^��®'.Nollll��tltll lla i �'.yuti t inc/— }1.t [l l/ ill IO P'9, �l[1 •edtiii/lnts „finis..n. `-&l❑Yes i /f �' �"11/�\ I 1 (/ U� p!l ,! t30 KEre Autopsy Finding.gvaiade TO Complete de Cease Ol DeM ftl METASTATIC FIBROSARCOMA -n(t /it\\�1�� '�I1�1 nvs i�"�\ nti/- "�ctni r�"run sr."���sn/❑Yes�l]• B� 31K\a`d Tobacco Use Count Td Deatn7 % ., 32 uFemaa�����\\��n \`�i�R V„, --\�i>0-LL''t O1paM.N `7tb�+n�n ♦ L�\1, P��11R;:titcT 1�It/lt,'a '� ❑ nn e+t ❑wer Al ma.a�0 wtw•sYa eunsr• om a I ®Nayral,❑HpnuWa 0 Amdent ❑PTCEN InvesCpxnan \Y ee/ ❑Yest,9",nti®;No ❑Untie)- I /I//_U1RIT,�/,nlltll>%///D Itl JL3 'ln ✓/II11Hiiv�/ 11 �.6tgtls�.y 1�• •'^,#- nua - `G n(Ilnti//:T1LI,rl/i k ..� Y ❑ ^!>n'A "��+uo.n su e.n.o-nl)11101+.�sn.nvewa.,a ru � 11 �❑suede.❑Ca1tl Na 9e Deternnea/�al fiLTl/'llttll It /L 3a'Dot p byurtivDaylyear). -}� r 15 aT Of InArty'° ./ V v <,36.•Place Of iyay(EG,Derede .?Ho^re CauxWn S R ant Nboded Area) 93] Irltay N NGk7 U ,, ! 1 ��U'�' �`�'II �� �U 1 \�11 k vestC❑No , /'(1 ; ` � n\\\ �/11\\�/ISr`S. �L V"/ln\\\ 11 (1 ��'Q .111 /�[\ �[I n� ) ,38+Loravon OLlrnjwyi5txs' 1 !r Ti,36a Cdy OrTwm T 38b-SVen BNunber- V ( ?AIM-/' 3605 Zip Cade � j. .T�\ PSC 1i ,Eua j 21 tryayn����`-i.G \',1�����1�/ R\ve�o.c \41`�p) Oor;Tu«..'lraO�..et�v LJ MHO/.nna7”-Si= '"ttl ��Oo /11{111a 01��(L r'>` �n111 O�l�f�n�1.111',n-%Ii�fln%11iii�'k a.nl�a %[l ftu��/lflnih�/�ul[Iin�%/lu1)•r"_S�Sndi1111 'J ail Sguare Ol Petem Ce{+fyvg Cause Of Death:llu lT///.d15Intl% ����� ////���1744f 4 CervSa7(Cerorx ONy One)l 11np1// fs{ ;�� ���}}�p 1 C HARSHITMODI[I:BYEL•ECTRONICISIGNATUREI �t�n AA'�1111G��.'_,?i11.®Cttyig Pnys,asN9 OECot,e {L❑HerT a:cerf..�'�\LI.I a3 N me,•Addresa N,d Z'p Code Of Person Certfy'ag Cause OI Deana- " v "- v 4e tcense Nunber a5.Data Cet9ea (1,�//�dl % If l//, Mr,mr.. o i h cycl`1p�(���at1Tx5-}(tey Itl�t rd0., �p{(�l/�j}{ -nco, i11 HARSHIT MODh�l600 MARYi STR EETA EVANSVILLVE, IN'47.7477 1U/ I1111U1. ,ll�fl�ll'yll�/. 01075975A V[Ilft�// 11411107/13/2018�// a6 Adeweal Funeral Service Provider. v 4] A ,. U \ U � <9t ,rr5-I tLanaP HTa�nro•..Irff 3! '-'1111ft�%//FTl[P�% 1'tI '�(/ `p v l��[(1 46 } ((•<vF«Replatra only'Date FCC Y�„emayn'e�ar) ry1) "\ci RICKYaBWEAGER;VIA ELECTRONICISIGNATURE�,t1111� I„111�O1 Yin a J11'1 ��i1111I11"1f1[YIJUL:16,2018�/�1'1 ti,,aT' �- ;:vRir%���lnt`//CC.W v. illriL li AMENDMENT TO CERTIFICATE OFDEATH(ENTRYOR ORIGINAL)`111t` itl�//LC��.Ytlll`J�Y, d �v1BIei ol 42sp :✓��n�`'��?\!!!w�VV ODO,. �+8a/J�nioo Tim` \�li�n_ ,. jnt`\ �eR \ �� ��\\, �(��� %State Form 53395tV ATTENTION ESTATE.The Soeial Se&2it p's tieing requestedCb�y Nis state zip hey vi ordei.to pursue raspo ithIbtyp'Distlastire is volun aid there wtT be no per�a to ietusal i N eAck THAT (WARNING.tTOURNIN FRDOMOORAMENGE-TO.YELLOW tieing RU BED.ORIG NA ND Nm TEMENT ASAHDDEN VOID ON FRONTTHA APTPEARSOWHEN HOTOCOPIIED.aA� torah - - - .