Death Certificate - McGregor, Edna M_5/9/2019 it
�re • \�� ' i ��[�/- , , 1 �INDIANA STATE DEPARTMENT OF,HEALTHr�, � / - //
a l to . , I r -> /- .I,\\i. ��: II�CERTIFICATE;,OF DEATHO ll1111 11 .f1�� ,111 ,)l ,A%'` Racal No 000055- 1� ▪ �tEDR N 00 000703.284 r State N 017bit; ,� ./;
••t.Decedent'sLece'Nyame((Ers�t�IATme1asn% :I 1-i ✓ U-IIc f /` V S .ta-Maa/Eeen Name'Offemae)I{ i- Ii 2.Se. 3, •'33{'1Tme 0tDetni .4 Da OfDeaN(M tbtaay/year):
�.I o 1111P11.0 '? .. Y/ilt,ll11, Ip l:� ,' t, 1 4 1a/g111 �,lh`;1 VG- - lit ItJ 1'� Y I,A1\11Il y" 11tIIi '25:52A i eir •�
• r EDNA MAE•MCGREGOR h��01i �1✓,t>C� DURHAM 11 1.1 a :FEMALE:' 05.09 AM�`! .11 04/07/2019,, .
q¢'tA�:5`Sooalsir-1, y Nome 6a Age-Yrs(� ;BCaDmet Yea Bc .”rl Me,.h m. Urgert Dry ee.;UrqeriHm- :Jet°
10:If Death CYAa red In A Hospital✓ \s 1• I lc IDa. It Dea 000JFTed Some.. mz Otter Than A Hospbl% 11 I"' S
Qs \ \i'� \1\lic �\�.'\\\�- e - S '`i Hosyrc FacSiy�iO1�pereEergs/�Hame\® Nurs,. HmwM,pmnn Care Faalry � �
r�'011yes�.No O Unirid/ �.A.�9t EliaDepam�ewru O Dean mAmval ❑. lM%�[1`i~//�1��iJ` � \\� elm rl i...j\�i+"o
- P:11S Facday Name.Of pot InY,lman,GraSteetaid Num;er)%{l+t{J tit nip//'>II•C'i �'% 1" l�e/ 1; '177{{l/ lt!1A'I 1l lj G74�` {{ - ,jy11 /4�j,' rl / '(I I?I".
GOOD SAMARITAN•HOME AND REHABILITATION.CENTER slilt1l-/� 1.11� �t i kart i'T�L✓/malt•.V.�l, t•
ttt0.;:,-utun [ And 17n e.� - ,1��\ • .'��V T '.:�,-/D .ti/ Lam D �7-,��, ,AV 'tM s Arc rDDeam_ .-
/AI 1 i 1N1 i, Y r , ':. • ▪ , ✓ + i-• ✓� r, ii t, %�1Mamea[70Manier ®n artr9 i❑ pv«rea.
P OAKLAND CITY•iIN 47660 -' ,t //�\LI � 2 ., p.I,t ; >l.�i:1;V GIBSON1IsG/%V1141 �,l lt�l t.''s®Lvtao."ceO�N• u � untm„i
jy;(> tl5'S,rvevp C,+„ sNa-e ll f NI.'
I 'T'- tl 'q' 115a.
a IutNane Before FrstMatage \.tl t--' 6 Deceds,rs Usual ocopaion s'17 Krd Cf Brsnesslm
a .Pr /4 ' 401 Cr, 11 .CI:' t {�\ til STORECLERK !h, A „, RETAIL >t1
t//$18'IResdence Sb'e• V /T t Tom/ r)P rl8a ea:7n a,// a 1 /-/� , I. 18a.'City O,Tomi � 1 1 t r
C* 55 �u A' ✓'���'1{t i it�/� •t;� t/,;, ;,i, ail ✓i-- yl I IPi tg, i ` t i`y.1:iti��i l 1, ��p ti
r '�\1 M GIBSON:2 i 11 a1� �) ESN. T41✓.s�\-'� \1.�
w INDIANA� �4 � .s -;a-. �'1"�• 5�\\�. OAKLANDCITiY\ S'IYc\. tom` `
f". 8c'Street Am Ntu Oet. -, e* 't --c-' 1S .' %. - It' J a 1 1 •'-le4 x �I "c 1 / 1 y y//1:' - G//lfllf /, • / �}} Apt!Has•/'tec Zip Code I .18f-Usriee CM1YLm'si�
(i� I�: • i ✓ , !l :'�11 1�i. II -- , 1 11,. J 9 I1 11 1111\�� !)1111tcr - l ...--0
. tl
11� 731�WST)ST��� • il��c'lll��f��1 /irc� ', • i/�P'I ��' , �� / !,1 l/ !111,1. /i , ®Yn�0 INo�
- %u� . �� It it_/ce t '.hm I � t„ 47666 0 <, t l l i!_
Ct��L\ 19.DecedentsEaumCm� ��\\�_•� 20'Decedent orHspvuconen\• \ 21 DeceamrsRan 'w
�Fr`,% HIGH SCHOOL=GRADUATE OR GED� �1\� '/� '>- -, S����p�P �G�i,\� -/i;N / • , ` rem
lV ' COMPLETED.ii1% (,1cti 1iiItt t� NOTiHISPANIC 1 i ll111.�1/.III White�tili�(1/;✓IllLt ., t-, t1211 L//i , 1,,. I
r\ sN\est Mtllb\\I\cr_ ill.4. II \ !✓ 1 I23:pa-eat e(Ent.Mtldle ten)/.14 ,1 5 A O t}I IT '23a'Pareits last Nana pe`orep tmartwp,
(14 ��U� A'."!/VA �V ,1 A l l 11 )�VAk 7 1 U C.
'�
OTISDURHAM,� I a / , _ 1, / .,� • ) / ALIC&DURHAM �,,� /�,IR�� %L BATCH^ \�/' :.-%
I.2 Ir�rnant's Name' i i I11% U. i II r 1 24 Reronemp TO De ,n {o� >24e.Mating Address'(Street Am Nnber.Cdy State LpCode)/ , i P l:% , ,' i - 1
w, ,,a„,,„,ELEY �Glois OR, S ) , i�l t �i1'o, /f't(.1�, Jil709.EM:5. "! OAKLAN11 IIW IN4766�00 t- % t 1t��1
0 b WESLEY.MCGREGORie% i d��� SON. > 'C\s f;10709 E:1125 S110AKLAND.CITY,IN 47660A-,' � ,% �4..1111a .t
Q i>OAAVA-S j AA 2'( '° 2 A'C'C A ' i A�/'2s.Pbce Ot i pos ionlN%Ln\�AAna AAAAC• MV•-•,•<- I.AVA� -a/1nAA�I
I[r� 25a Memoda ps osiwn - tl .,rv%Ii!` acelOfUSWNxn (Name Of C�mCrenuary,OCserMlace),:25c lsmta, CM:Twm:AMStxallti -..„?...-.1..1.„ 1 l� .
W y ® Biilzl 0 Cmmaint,o oauxna Ermmnmeo L, I +J \\6t ll�/1 l d '11111 r 11 U 1 / , i
�� Remora-F omS��,'"\i! i,G�\�U �c - 1t�\ ; �r-� i1 1 1Y ,t.S ,� 1 ��1/,G/ J` I
o j•2 Darer o oy�/;,. `\21\�\ BEACKFOOT CEMETERYI�, \ /.nP COE`IN\ .r e a i'2,r t\\lH neL\\��
0 28.- Coroner Ceanee'F ,;'j '27 Nax Am Cenget Am s Of FtnealFaofy v� ' '"//9 +1y///l{ /J� l ,--
�'U� ❑ I{�/ i � ls ' t i/�P ur / , 1 / C 11 , 1111�.I1v// f rtejiY� 11 t1!,11G�a Ptne'al Horne-terse Numoa.:
¢) ❑,YAt'llA��!}� ,, � LAMB-1BASHAM MEMORIALCHAPELt4IN 2 E AS I I. 1-TREET,OAKLAND CITY, t1p,lu I'�11;�1>�
al:.
1 • ��� e.�\�:'lll IN'47660�\ZI%lam\�Lii s'!Ih t 'a& L •.UiV, Vlit. A�0 4 FH83005312a. '�:11,
J--JERRYLEE'Btre Of ASHAM. Y-E ECTR�ONIC'SIGNAT REi �\i���3- ' ' w� FD 1O165892•i(a\reee/�w. ,�I\1
�I //�4,t>" r lr5//illl(ln //. FD01016589J //�lil,l,.,/ 1,.-_ �.({r _ I
4, L41 1%�1u1111t% ti pr��/UAllt1%1111}11l%Gtr5^ao;a(5..1� ° a�^a E=amp/e�,) v `, 4 I
LL 4 '28.1Fart I Enter:The Chain Of EventS,..:D,seases,etltrles Or Co nplicatims That OCedy Caused cline B&UI Dot E iT tom Events\;III Iy� ,G\\IrieKrat D let I!I i
a, St a As Ca,dac Amest,Respwatory Arrest,Or Vermipular Ffliillaian VAt oUt SI ,i The Etiolo6y.D6 Not Abbieviale inter OM'Or'e Caine On ,. \L �\� lL�� �jo Death��
0 SALine Add Aedbaial Lines a Necessary\�� \ / 1., S \t"/�(-1\�� NJ- fl���i�l ti It,f\� \\ p,N '
Q lj ocij llf C'c th1It%/JIIAN 9)11,t G ,p 1,1 l/ ' t O �1!7�1<///1'�f 1 . 1� , "C a I\:�1.�) ��'
Mmedmte Cause(Fa,alD,sease Oro,dtian'.1(-'*1 NOeath) i.! Ae.SEPSIS .1 .•-a ' A. Ill 11l'�i. iI)ll �1„ll,lI%/ii 1 1'WEEK .1 ..
>II �// itit �Ug111/ J111 :. a,II)Ii //� l/ *UfII'�/T l� l/ ,111 16 ,1 ,✓ ' ) 1 %1
��� \\\\' � `�t%�\\ 1 •`'\� I��B" MAS�GIRSnIT . •, —lt
\\.- Il, �\\ KsL < i>`Sequers,aM Llst Cordams ttMyLeadmg TO The Cause- Lutetl On \ COUN.Y ��DJ� ,
f LineEv Enier The Ui.Ino bcause(Disease Or!FiuSlThat lmtla ad/// ' \\�/�111p i ,Il{' +` o�j` ri f- °r - rN`�V '1n S 7 1 11('\1
F- �7TiriLventsResultr,phDea )l)Lest';� ,I 'ii!11ri/ 11' li� C uIL,✓/ lI\% ill % tI,,...-;lit%/....° 111i 11U!.lR l!!'l1,- /f 1 _ � Ili!,a,,I
�C. j�� 11;: // ia. U l� t4G t ui 1�aeV . 1 - % /1,1 {1� Q III 1
Pat 11 Ertirotwr s:nrart.r.,tf:Sons rat,b m o Derh it
Na Reading I,The UravW Cane Given In Pat Ir 1 29;'Vag An a.yy PerfreC'r h '-•� 30 f,111'^Y , t //// ,t , / // 4 ," �ll30 reAtusa.✓// ��%OlYes i®IDe ��
FT EMOORA�o�RN 11JRE f111 v U1)' 1 1,. ✓//Vt�1`1• //�C` C44 30 er-e NaoitI ilCxq.".AvailableAi c.4leteTI IV?".eOpl t vti s i/
f) LEFT FEMORAL Use
FRACTURE if'i emSe//i !%c% 111{11 G1//�( ll�lll l// 1' sae innE 33' Y/w.,,.ln Vi/.ram•-n1u /�iYes.�O_;Na/l
(/, 315 Did Tobacco._ Use Cetrh '' DeaTi" '32:u`ernae`'`\\� '�\\\\�U\��\�'�`�'1 '.,C�.y,OD. ltE:v Mane a D.escide 0r�\� ,�-��r '+
E\r>n\&\V>�N�\-mil ll� E: JI ❑-r,«;nwiIIIrt m4s ❑11 ' arm.ap.s�O;raa,. .,ae'e,.a.itviceao.nacc 13 O"..O`Hmu ae�OlAcci n O Pamgltrrrssopaman
� 0 Yes O.0 haft® N ❑ Unli. _- �ee P,. Pe/io 1 , ;ee//-oti >� i/tene C veil i'i (I id. /ed p,.n i/,,1 , \
1'li'IIIULII%/.III+t1Y.�/!� 1.> ✓ 1 0.seA.wM1 ean.aasoo. ,;�e.s..cw,ll i:fO:tx.. sanp.ave,n,+.es nu��`t O;Smpae OI CoJd Not Ba Dem„wea% �'x� ��111il„
,..‘'.1 3a.l Dab Oft y(Mo•NDryfyear)i ///11 I35.SKY"-Of InNry, l IU,IG .36 PmceOl Inpry(EG`Decederts Home:Caunucmn Ste Restatra,t Wooded Area)1, 3 31.:,ivy At V.G,C1 )1 )
C ,/ ' 1�k �1 LS „ , , l / -em u"& Lc/•. .. ., „ i),/ > I ,,t . .)11 �. I'
i ;it, 3B_.� ayoyrsrm p�� 11 w j Ic4• aTe./, I p tl;i:3ee;star&tbr__ppor/- I I vl7✓a,,1 �_ 1 +� ; 'Aa Np 13ea apc"1 }1/
(CI i�� ��j�j ) 11�(11 �; 1 L� )�i' I iIr II',,� �I1,0 ' t ,I �i 11/1G��� ''1 �� .111 �iv// '
k, � IIIaI�,:�l1c��I� ��G�)1I4 �,n�a 1 1 Iti. al ill{ ,.,,n 2..tt�l�1/// l0,1 .. .. al,% i
I I'- 39I DesaiOe Hwv UTrY0csTeC \� - - \\•, l Il Ttmwx+ Injury fry �` 1
.+ ;1 ;p p �� \ \� \\� l\ ��� \\\\\ ❑os.ti.e a.�,sa I e...us.:0 ore lsaal c�\1
���II (laG/O >.1„ iL.1li.�, � _n,., i ,t_ -✓i � u i.�' fin .let. /� ,�//�ll.ln-/iSdIL1. �, i'n� a (n_)
cpi_n!Sipuare Of Person Certfyeq Case DI Death:hl!!lC/!.-ildl•if' -C 1.1l11��; }II1 ,r 3I;V` lu���� yJi A2LGmferr(Cne tail ✓r hIr1 l///_1L'll ,S i, `' Ii
u AITERRY GEHLHAUSEN';ABY ELECTRONIC.SIGNATURE -' • —,i -Gtt& i .0°„Lid- l %Sec6,mi gpfn�:UII0-Ce�l Qtico'H;�omar 0��1
w�i j%1' es:And
icy"tf PereCn 1�%�10�/ ' �;, �%11r i�����y�,jj c0'1 1, l -TA iirtiber � �� Pea"CeitCed /
it-� IITERRY'.GEHLHAUSEN,-,.1020,W.•MORTON OAKLANDCITYcIN'47660,llih 14 MI .III -tj� 02000730A111!!11�. I !11iO4/09/2019
I ids.,AmiSmal Fneal Sence Pmwaer.- U P v "T i- U / 1 u t� ✓ y 42,•AFasi a ✓i e
r5�� ��u� ! li "..d Ili %c�.��:►.- ' �'n �411 b. 5 llc tli �1
I •C.'.. <slsmabea aHoarna�`Vit . tllt-IWII V-- Pl:Vvr �r C!n '� -e�7 Raglm� ,:D�Faed (Me-ViRtS �: v� V 1
>,,, I , � f / AS �I v {i�)
fC✓ BRUCE BRINK Ilk NIA ELECTRONIC:SIGNATURE�111 11 /�1111'.0 � a•<,mt� n /��IIL(tn %1111�AP.R-10 2019 /� Id r �,ta,i 1
\-'(nI'1111U/�nV116U//.•1,:I'L, ��U1111UfiiPic'AMENDMENT_TO CERTIFICATE OFDEATHIENTRVOR ORIGINAL)llliftll%//.9 iN111%/G.tI II lilt%/ • 11 - U1;)(111
r;1 ,'� % c -Ili , , 11 tit- „ r g ��� . no t I •� Vt 11 1.1 , ^7 , / ;, , _ �1,1 1' i 1' t l . , 1�1 � Iii \Vi:? ✓/U1{nIt
I 1 ti / / 1 / , �� I V
�0 1 : \ �\or.�\�ir �j\��1�1� 'iXt\.\�•in��r1 `�f•\ �Z\\mil"
t i,/State Forth 533%!ATTENTION ESTATE'The Social Seomty e u Ceirp reguesteel by this state agerry n order to pursue respons Cary.D,srbwie is voluntary and therevall be no penalty to refusal. p
/ �b lt9 // Out -/// un�i tluuel�RE BACKGROUND
Ifil ONSPEC//.,I1ITE C 1111,C 11111tL✓//b OF,THE
Uh r/l/1I pin,ONBACK_ -,1; \Vp
0r i�ti//t p- ' Al/± ,ORIGINAL DOCUMENT HAS A MULTICOLORED BACKGR IUNDONIAL-WHITE SECURITY PAPER MID,THE GREAT,SEAL OF,THE STATE OF,INDIANA. ON BACK THAT {l II`,
111IF1fllY DI V7-'TURNS FROM ORANGE TO YELLOW.WHEN RUBBED.'ORIGINAL DOCUMENT HAS A HIDDEN MOID ON FRONLTHATAPPEARS WHEN rPHOTOWPIED� �t1 !//c:_ l
r JZ 7 `"TJ-� CS"- 1 CJ
yr L J. ,_ ��. J:.l= _J:11--� _ • a I a _ :=v-'; (C:�V'�2'�'. _ -�/'.'�)l'r t` �_.... `"'fir .,.