Death Certificate - Prior, Laura Lee_7/10/2019 Ls r S-Arli rta-17 ,trn„g00611rr`- v. p-= _ - 'ZvsvS.:.n�.�rn�w.�,rar plies.. _ . _
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1... ,----0.-/-0.- INDIANA STATE DEPARTMENT OF HEALTH O
$( si CERTIFICATE OF DEATH
C "e Local No 000068 EDR No 0000007071 99 State No 021448
c 1.Decedents Legal Nara(Fist Middle,Lest) 14 Ma!den Name Of female) 2.Sex 3.Time Of Death 4. Date Of Death(Mortiv9aytlear)
s
Q LAURA LEE PRIOR SNYDER FEMALE 12:30 PM 04/25/2019
5.Soaal Seo.m Nutter 8a.Age•Yrs as Under 1 Yew Sc. Under 1 More, eta under 1 Dry Be.urger'Hoer 7. Date d Birth(M.aeNDay.Year) B.Birthplace(City erg Sae a Foreign Camay)
Gr
Hosprttl •
0 Hospge Focally 0 Decsdetts Hans 0 Nursing Hanedorganyi Care Fealty
fr 0 Yes 0 No 0 Unknown 0 Inpatient 0 Emrgeny Department arpetesl 0 Dead on Arrival 0 Gonr(sp.dm
d 11.Faa:ry Name Of NotInset-Pon.Give Sweet and Numer)b
C 1701 MARTIN LANE
( 12.City Q Ton.Slate.And 2p Coda 13.Canty Of Death 14. Mattel Stab Al Time Of Dear •
• 0 Mined p Mamed But Separated 0 Divorced
PRINCETON,IN,47670 GIBSON 0 Wdo*ed 0 New Maned 0 tldnc.n
15.Suniit,Souse's Name 1Sa_last Name Before First Manage 18.Decedents Usual OccpYxn 17. 104 OI 9rsnenlydwey
EDWARD PRIOR NURSE MEDICAL
J. 18.Residence•Sae 184 Cony 18e. City Or Tamtiv
4- INDIANA GIBSON . PRINCETON
( 18c. Sweet And Number 18d.API.No. 18e Zap Code 181.Inside City Limb]
I1701 MARTIN LANE 47670 ®rev 0 No
L.C. W.Decoders Eaaaeon 20. Decedent 01Hispang Qign' 21.Decedent Race
UNK
,- NOWN NOT HISPANIC White .
t ' V.Parents Name(First Middle.Laap 23.Parents Name(First Middle,tas8 23a.Partite Last Nan Baba Frst Mantic*
RAYMOND SNYDER ELIZABETH JANE SNYDER HARVEY
24.Irttemenrs Name 24a.Relaemslip To Decedent 24e.Maeda Address(Sant And Number,Ciy,Stale,rip Code)
CHRISTOPHER SCAGGS SON 23373 EAST.64 ROAD,WEST SALEM,IL 62476
- - 25.Place Of Gsposicn
I 25.4 Method Of Cisposta1 250.Ran Of Dispos!mn(Name 01 Cemetery.Crematory,Other Race) 25o.Locaan-Cey.Town,And State -
El Brut 0 fnmaoon 0 Penton 0 Ereattwd
, p!limn!From Sit '
• ❑(Ste(wren). CREST HAVEN MEMORIAL PARK CLAREMONT,IL
e 25.Was Coroner Cornered? 27.Name And Complete Address a Final Fealty . 27a Faecal Home License Number.
•
r 0 Yes 0 No FREDRICK 8 SON FUNERAL HOME, INC.,313 CHURCH STREET,VINCENNES, IN 47591 FH83006944
27e.Sgnaan Of Indira Funeral Sent*Licensee: .- 27e. license Number(Of Dnnee): :
TREVOR M.SEED:BY BY ELECTRONIC SIGNATURE FD29600028
Cause OI Death (See Instructions And Examples) Approximate
8 Li2e.,
Part L Etter The Shan Of FVPntt -Diseases.Injuries,Or Comp&mlions-1.2sat Directly Caused The Death.Do Not Etter Terminal Events M,evaL Onset
-Such As Cardiac Attest Respiratay Arrest Or VerVnrlar Fibnllatim Without Showing The Etiology.Do Not Abbreviate.Enter Only One Cause On To Death
- • A tile. Add Additional lines II Necessary.
• Immediate Cause(Friel Disease Or Canton Resrang In Death) A CARDIOPULMONARY ARREST ' I MLNUTES
>! B. RESPIRATORY INFECTION DAYS
Sequentially list CUrC.t s, II My,Leading To The Cause Listed On , owwla a cn..a..w do .
r Lire A Enter The Underlying Cause(Disease Or O4ay That nitiated
The Evens Rowney In Dean)Last C .
CM w la u A oweaw.cry .. -
CtD. ,
p Pat II.EntrOM Siaiecan Conddonf Connpena to Death&A Not Resd:np In TN Underlying Cause Given n Pall 29.Was An Autopsy Pedamed?.
1v0 Yes 0 No
30.Libre Autopsy FaCtg Avaiad•To Co..:,ha The Cause Of 06=9
rr HYPERTENSION p Yes p No
31.Did Tobacco Use Contrbute To Dealt? 32.IIFemale: 33.Manner Of Cernn:
e .w mewl van:e.e my 0&rows.ma bum 0 me mye ve.0 pinyon& ®Naldn1 0 Harmde 0 Amden 0 Penang Lwueasmn
0 Yes 0 Pmbe0 0 Nop Unsnom0se"newt ee"ny.tafan Ts,ye Wen Co. ❑uese amawuwen Tr Pee Yam ❑Suicide Call Not Be Determined
LL 34. Data Q IniurY(NonlY0 y]Yeer) 35. Time Of Injury 38. Ran Q Mary(Ea,Decadent Home,Construction Ste,Restaurant Atoded Area) 37.!Sty Al Nona
. ❑Yes ❑No
C''; 38.Loci nOlTay•Sut '38a. City Or Tam
H011atibsnM 38d AµNd. lad ZpOdde
t. 39.Desoto Hoe eery Occurred A0.If Transpatam idsy, 1y
ppoaeorn•.: pe.�e.U-ew.pde-ts-'
k
41.Si IatCe,Of Person GMyvq Cause Of Death A2.CertYw(Cheri'
Q*y Ore)
RAMESHBHAI P PATEL;-BY ELECTRONIC SIGNATURE 610Z o I mnr ®C•myinaRyaician ❑Con 0"er'D'-n'
43.Name.Address And lib Cade Watson Canls4q Cause Of Death ee.license Hurter 45.Data Celled
RAMESHBHAI P PATEL ,685 VAiL ST., PRINCETON,IN 47, e i 3 i L 01040266A 0 510 22 0 1 9
A8.Addeatt FuneN Sevin Provider
AI. 'Alas:
"- EMMONS-MACEY-STEFFEY 1� ► .
a8.'SyFuwre d Local He i Oltar. 49. For Registrar Only -Dail Fin(MonfvDrytte✓A
BRUCE BRINK JR,VIA ELECTRONIC SIGNATURE MAY 03 2019
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
A
��-11 - d6- �,o3 003 . IS - off•,
State Farm 53395 ATTENTION ESTATE:The 1Social Seaaily M.
is be'vp raataled M lnia stale apercy inorder n gusted respalsaffts•. Di.ew+eva Is voluntaryaM Ulan will beno peNdy forrehmal
••a a rs a e a•a _ ORIGINAL DOCUMENT HAS A MULTICOLORED BACKGROUND QN SPECnl WHITE SECURITY PAPER AND THE GREAT SEAL OF THE STATE OF INDIANA OH BACK THAT