Death Certificate - Sinkhorn, Robert G_7/25/2019 Vr� r 'Ai. ; ----" ac�fr_-�' e`0,,-;�'''CERTIFICATE OF DEATH '` (/y��` te; r �,
�eaY'Z.S"� ��� Grn�'
r ' <1;'ILe al ha0010047w �- J>%EDR No: + 1. 1 ` ,A `\�\
�..
,1!✓ < jr, ��y ,�� i �alib �,f111ll , 141. i(t7 '\',�-jl'l:: it • \A1�
..1l Un�A c'L er . A MALE d . 04.06 PM 4 3/17/2019
r`.5 Soot Seanry Nvnber et Ape�Yrs,- U I Ye Sc Under 1 Mort, -41 Under 1 Dry 1ST Under t�ola 7 Dx of BvT'(Mo_MVDaY/Yeari. a Bert }ace 9V and Stxe a f,FiFi Canty) --j
� -•%1In ,��� -,- -ilr / iq - 5 /i- `P 1 / 1 1 1N�
Ra
1'C< �At. ;r %SlVa�`I �. � v .lL.e� �, Faa 5 DecedpRSHame y�vAA d� '�
�� . � ���.� r may_:,. .A� r�..x. D ❑"� n . ❑ "t.❑Niaan2 H�lo-wm cam FaPxY �,+�* '1
❑.r.f .®No.❑u;Lno-nt.®.I.Panern❑Emwt-r2 ammena,-. e 114❑D�d n,Air .p°a,n'(so�gnn)ja irr �r v���1: . -'" '1„1 �� 1 >� a ��
w .; � . oa✓� (Zwe 1tirrW4 as c-r; 1 ar � N+��- c- �a� r- -- t j 4�
% It !Fa SLyN GENERAL- H SPITAVC" 'eer)�%��lI ir'//,i11 )� 1 iP��� 1. f Ili.—,-,,„,nor i.-",-"-; nY -t . r. / , „^. / (.1 '
- GIBBON GENERAL'HOSPITAL"' 1� '%i1 I _ iI ld �>C�i1��11�girl t� �,1 1� 1`"� 1�i11 , ..011�' r�i �H��� lyi
a, <✓�or1 '� A„d2,,p_ /e% �:� -. \\�, ,\\ �� \13 Cony Ofoest / �`, 1� _ i4 u>11,1Slata rr`D m
�P PRINCETON IN;47670 �.., / 1 - - .'0 Ma<nea❑Monica®aSepa'ated ❑Drvuua
' GIBSON 1 1 >'i 1 ;❑ ' re. O Ne named ❑unarm
6r I 15'Surviving Spouses Naine 11 t 15a lot Name Bete First Manage -18 Decedent's Usual Ocapaaon 1 017 Kind Cl Bosinessindusty /r
� MARILOUISE SINKHORN //�.r 1 1 v.� i t JULIAN- ".c- 1 �//.1,11 MANAGEMENT.- :' �' MANUFACTURING s' 1
r4757;.State �// Ir lJt/ f1 �19a'CaWy G% - �Yfl 1 ! �18b Cfj OrTwln(' 1 i��� ; i1 �,,f/ 'J / p(/ j" 1 1
1 INDIANA��� „ -_ A 1GIBSON� �, � S PRINCETON"- . ��il_ � �A `2��. ��
Ai.�:SreetAdN,rt r ,t � - ....'s '�)- 11-- ii '--L 't��/lucre�( 'It Yls� j' '18d 7(1°1;,7 lse. LP_Code I l 181.taMeCtylm_mo/
21 LAKEI i 1 k(((',���e t.Ii Gi.. .(,'i li Wit.;.1 �'\tilUti Q. .Iil�II I„ li !4 1, �1 147670 C4 1 �CvVlO N
i ��� �.1�\� ,1 �Q11I1.� �.� � (I to
19 Decedents Educe[onA �V•��V A 20 Decedent Of WWs 0911n A - 21:Decedent Race A�� - ro
3, HIGH SCHOO tGRADUATEI,OR GED�' I vvw`��� 1 %/1��j t ' A��11 1w�° il�� �`�%�'rw`/1 ��%�
COMPLETED.A1// 1!I :ti llniw - NOT HISPANIC ! trll'!.�1l11 White aIll'IAn ,.' I111 1, ✓ ill;i t,�ii- ;,fr I.t,%
' 22.Pemro Mame(Fan'Ndd.e;lest) 6/// 11// 1// 23:Parrots Name(Fint,Middl lent)/ ,' l 'i_23a:ParaRS Last Name Bean FvsiM
� u � -' C�>°Vt�c1�1 /V� ly .' �� °�'�1�A"U]' \ ,"I \*111 V��� >' �A,
LESTER T.SINKHORN/71<r /a l�. '.+���/ , — NAOMLM SINKHORN>�//7t1�i�11 MORTON'.
' 124'Inbrnant's Name/1 :y,1 /••1 il 1 2.a ge>atrsr.pl Decedent ll�j•al URll (Street And
' tuSIIr_ JitlIIll✓�11 i1 p/�iilniI/� 11
i.%ham III %. •/ //i I G "i b '1 T I + 1
/� 6 . /
T 1, MARILOUISE�SINKHORN't � I. 1/�:�� WIFE. c� H��i rl� 21d:11LAKE;ROADGPRINCETON IN 47670\\\-V�-�\�i.'I. ` �L-t
w?�'IL\% i^4\\1 Yrt. - \ ,\�\\in\\\\ i\\",44,25.'Ptace OiaspoaemiiR\\ -��n\\\\"iiQ\ \ ia,N " s \:`- i%-
. 25a.Merlod Of Disws,?m /�..IL.,.c -' , 25e Race Of Pwdsi:on(Name Of Cemetery.Crematory;Oyer Race),. 25c!scathe-CC•�iy,TunAin State t. It V 1il �� 1 I,1t .)
Tr ®Paul ❑Crete❑Dauaon D .d,cmere ' // ti ' '.%. I I %//I Il 1 -„ 'I 1%s 11111'// 1111t11 1 ',II'.r/i I I''
l� / / `/ 11, ' 1 1 11 �I i
■ i v U / / / /%
e ❑�01w,(SFrom sxe J i/ a/V�'. HU <1•� SIG �� / V�Ii \1�i I ����
IO'. dspedm:--i.nAA� ,\ . FAIRVIEW CHURCH CEMETERY-V�� ar P.RINCETOWIN ' �i r�V�-� QVA A��
M k. a �n11Cceamea� 1)�j�'27 Name Comple A>dr iOf FalmafFaatlfb II II iI�111 I.1111i-/%l'-II11e/�In /I. ' tkl���GYTa Fuel H l<ene Numcer
it ./ , l/ ��f� h 1 G ,,'-it
��It • %//
1 //�� , , ,1' r t�UfliR L H 11❑ 2� N MAINNJ1 111� -- ..0 1/. - l 1 /j l� , i / i /
J D;Yes=®No/� U��
iiirr- .27o \\\reOf In \\\\ '/= COLVIlt FUNERAL=.ROME INC 425 N ST1,I PRINCE I 4 79 ✓..c�� ee): FH830056714 `' 11✓.�'O
;270,Sp,aaee of Indara FuCal Service Licensee �O"\\\vim U E- 1 \-i - y 27c License Nu nbei(Of licence)f \i - ,-�t'
A RICHARD-0EAN HICKROD;=BY ELECTRONIC SIGNATURE�I / '.. �i nl1/i,% FD01012 31 fii1,1�G }. //.�1
•/ /i i I/" Il/� i1///Cause Ot Deatlr (SrIratruc4msAnd Ea lea /// C {l
'/ l'�I'11. 1/�terme11�/�Eyontii seasslr.... 0r Complications �iv1r e < rl v,i< i 'J11�-I .1. 1 II?' (\IA /to 111frtVunaerli V.
\ 28 Pan Enter T1iee at,R Of Events?Diseases,Injuries Or Complications That Diode Cauaed;The Deem.we Not Enter Term" _� l,�/, " , rl • „ 11 \To D a Tnset\1
A SuCI As Cerdiat Arrest,Respiratory Arrest Or VenMprlar FiCnllatic i WfJ1aa Showg The Epdbpy Dd Net Abbaviate'Enter On.t; use On 'i ` \ �\V"\-:�To I)eath',�\
� 'Luse lAGd Addtional Liles H Nxwcsary�\•p 1\� 1,�c �/, u�\� \��fl��� I n�/ i -- t1��- 'f�k r1 \%
ask.t //%t It baU/-9V 'llri��cWl %/�: �il ,� , /G tlnN .A1 "E,,:�Nnft /� II C ii 1 I 0 v
LTmedm.eCaine(Fnal Disease Or Condition Resitting In Death). ' A- 'METASTATIC RENAL CELL CARCINOMAI-// �/' Si%/ �� �� �' �� 1 .2MONTHSI A
Id- �lili ll Ool1i1 % '�V_ VIIw�I, 11i1I/ *rlloanroa , AUDITOK II i/�� j�y'> t
o, A �A ' ' �\�1��V B. CKO��y� �w - \ COUNTV�(�.�w +��'�_V': ' ��
,Sepuerroaly List Cor•.dtpns H kry;Leadug To The Cake listed On OCL- ' 'n
P 41 i 7 The Events R•ihe UI In I�atI L se(D,seasa Or Iryv'T t Inf fated I(1�,' U') ' Tees I'�`%/ I'U \/kl'llll\ , n'I '11.f
�;1 II �' � i n � � 11 , � ,- liul+l��ili�1 ��1 '�t / ,
,r't lil� 1�� 1' 1 1 1t1 = L ✓ w.el 5O-T2,4 i/�„ -./ ,pr tli /, I.
��.
.Pat lI:rrr OCerSiav:rAlt Ccgltail"
s CMNMrp b Dry',But Nat fleps.rN to It,.Urderlyuq Cause Given N Pan l� I l29'�M AltapsY Performed?a ..�❑Yes%.6.NO t l /ill l 1l f
% Iti11;{ I111111%/J}P1111-//.1;1\\1\)>'. -iltit1��iltl{y ���ilA "wwxreAvwsyFnmroAa9,w.IT�e«np�mecb,:eofDetm � IiI '
r1� HYPOTHYROIDISM-CKD DIABETESMELLfTU$TYPE IR t //, S ,t 1 /� _i'. U,, , iiw .nv / li u//muu !ayes ❑No-'
. 31 DidTobbaac UseCcmMdeT Dee 32 If F m e�-� �� -v :::.....--s_we 0 L,s '%�AAVA`i Macaw-O Desa.�o'\�-
/in\N\ /l \'N -- c.� p:.',n.,>W.,Ial• ❑!,.a-. - as. ❑1..»wa.u Pey.a e., Ow.C4Dee i ®Natral 0 Homidm ❑Accident ❑Pendng lmestga?ap
❑vas ❑araoady®N ❑Unwoao /I ,�i�1, vi /i o1 N i��7.e e e U n n� cat< /-...f v i welting A
/n HMI / t . // / ❑ A.oaa uese+a 0.n s•ue tt. W rn•w+ws.,aPr ..'//�I. l7 Sunda❑Caie Nu es Daiimpee�. . ,
• ' 34
1
,Daa Of IryurY(MontVDrylYea) k i,�/// 35.,Tux q Iryury j�' I 38 nxe Of Iryuy(EG Decederts Home.---C,ruonl�Sto RReestacmt Aboded Anal)`1 37 Iryuy At V,btj 1 ....I
alr �./4 LI' \� � �\1,/C t iC I.C �1Pj21.�� h�� \"II."`�� - � \�\1 ❑Yes 1 �o\�I
+. l 3C-cal;rr i tI :SmT(q { I a-3/ea,coy a o/:.i r /Dili t Psaea a N7 1' �/ { 'l S Sec Ap.No% 13ad.r�1 n±//
% ' 1 // � I '' V{ / i G�%tlft It-- 1. i1� l ids U ;j/ /
��j0 �l +yi'%de—no IS!lc-. \\ 111ki1� iCc,I � 1'.I-/„1-"...•1% lU. �.1c1; ..,_ h✓illl? . %N1 1
39,Desml»xarl omareo, \-r \ \V`S - N" 40.aTranwuaamewy, peofy \ . \, - \'
'ir L s - 'n'n ? *4-- . v+A- �'i V�%) ��',�'1, C CID,.:as'❑�rv.-a-4—❑o...a�a�
1:,11 4�tn t' fill ,,ccC 1t 11I %i` I . .�//�111�0.211 a .. to�ll a `//�ilfl %%Pull t>-rt t
."-
• .c 41,sgremn;Ol P.v. Certifying ClDetnrt9�/ IIt c-/ : r) l Iit �IN '— 11)11' :2'c6Aeer lCn gura,e)6//o H+,l G�/t, I * `�r� RICHARDMICHAELCLARK BY ELECTRONIC SIGNATURE% 1 ' �F�. l l .®cetiryigPtn�.' F❑.C«us<l_ h ❑Ses1Ofkero' I.
a\ ;Name AddesArdZgCadeOfpratC -Jytrwe.aeOfD.ao. , \1., \�\ 1'' \� \� "'°Num\�, \\ \�%
%'..I:1 b.- i h ; l I� �211,1 %.R 1�\/ 1 \ \tU O�� 1n\ i \// f1 3/le ,
itrli RICHARD'MICHAELICLARKl 510:N<MAINIST P.RINCETON;'IN 47670 tl nil .U11tt� Ilh 02004079A1I11P�ii `.03/22/2019/
I it,:„.-AddamYFv,en Scene Rwdec" UIi 5 Iir 1 //� UI Ul1IIU UI'111/ tllllfU aTl Aka � °UIII f/ 11 11 1 j \l
;i 4e-Stse ato Nen;asmr.'i - .Z;���%i,nA�i�(1'•V- 1 pp '�I �i •��i' ���. e11�(`%Date FaAR2 19'' �l I
t�BRUCE'BRINKfR VIAELECTRONIC'SIGNATURE�, 1 ti 1111IIP, //.,1I1tt.� Q).n tl Ili,
.:4--� ��.�t1 Is ?e .':`Slam t1U:&'6 II il,'AMENDMENT TO GERRFICATE OF,DEAT1(ENTRY OR ORIGINAL),))itili',-2fl'i y% t.
ill 'I.li1m' "' 1 t �/ II.1
�illlhhh ���A S ;`o 1 VA�V � r ���tI�R� i����� �(1 �� ��7i� ��A'.
pppccc ( R '" � //,ItI ; 1A, % 11 11 It i10/11It' 1 )1 / 1 % 1B n .'i 11 1,-
eel11 �j��;llli l%IN � t 16 ,i1 J� / t' eC. I k� �11� \ ' , ' -9k, 1 ��If i r1)i 11 ✓i
1 n`\���\'J t.\\\�.--n\fir \l \-��to\\'��lt\`\ n�� "' sr,Q �.:\ �
/ State Form 53395 IATTENT10N ESTATE The Soaal Seaedy 4 is beag rrenuested by t✓ris state agency n ender to WIs+!e resporsibltiry. Discbsure a vduntary and Here uill9a ro perelry for n`usaL I
rig,
1i 111111V-F^1Si, 1 /•ORIGINAL DOCUMENT HAS A MULTICOLORED BACKGROUNDION�SPECIALWHITE$ECVARYtP1APER M4DTHE GREAT:SEALlOF,THETATE OF INDIANA ON BACK THAT ''1'11
-� WAR N I NG sTIGNC Fnns nPlNfF.T(1 VFI YOW.WHFN.W IRRFr1 Y1R1(.INALIWaOIFNi Nag a HlrlrIFN Win on FR(WT THAtAPPFARS WHEN PHOT(YnpIFO G .. '2 i.1