Death Certificate - Wheatley, Marilyn June_8/7/2019 use.; �vsa�.�sa�a _ -i 'lg.C � a .- rg13.4
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...-, -_,..Decedent's ILeoaName:Fav-Mmle l`asr k'e+� �9 1,1 '. I t1la,taw«Narey7rcm2m`el 2_Se.ylt l 3 rneaDaam s,, 4 Dr:aDea„(Mde/Dayrcaar . ',
yMARIL N UNE WHEA1TLEY r \ �` j �y SMl H�'I ��I I,Al �l �I{t' {t��fi i%t}I t{i
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i 15 samlrc saeriNa , t 15a ladN erBerore FeatMarnage - 16 DecMmtsUwalOmpa,m 17,....Nmd Of BvuaiNrq
i LEO SYLVESTER•WHEATL'EY \?�i i I ,i� 1��I ,�/i 1 HOMEMAKER - ' \ OWN HOME ',Ni,I
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9 HERMIN SMITH. o '. .AA ; Avv/ '. 1AA- BEULAH:SMITH . llt wi ns.---' HAWKINS�vi% '
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I LEO SYLVESTER WHEATLEY ..,..�l t' HUSBAND aV'1 t1 235 SOUTH SEMINARYcSTREET,, PRINCETON,INC4767O: .. '- :Ifi
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� 26.:W83 Canna Contacted? /j-27 Name Ana Cmplce Address Of Funeral Featly 11 i ./ -.1 % II,'I VI// ///� II It ,2] Fneral Hame Lrsnse Number
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;�v.��l yy :Se DOYLEFUNERAL HOME 520 S.MAIN S�RINCET0 4767 211 \.I,. �1 10400010c �1
.2rospneve Of Undone Finaal Bence Licensee:AAO� V AAA v V�- ��.T,. v�o p 11 .:.._ 21q " �' t 1 V\
6• BARRET.TW OOYLE BY.ELECTRONIC(SIGNATURE II'!' ���1�/.'P. J /il'Lln. % F192 e ,-AL..1 / + .N - h� ;
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� t. {�i�Enter,Te %/fFtrP'I� .111/�11om1'� �iil�e ..hi t {L/Even 6 --- 4 1/% {l , /i .°Apparmanll{'{ I
at.Part l adik kr Chan Faints Diseases I _S ryiuies Or CompGtatwm Thal Dreay Caused Tire Dealt'.De Noi Emar,Temflral Event •
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WmeOate Cause(Fvul Disease D[Dond tan Resuh'up NDeaN)�. �•A--CHRONIC SYSTOLIC CONGESTNEHEART FAILURE�11��/ II II �� 3 YEARS I$ �/.',
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`Saa+ereally List Cab vom ,f Any;Leadrq To The Caine LMed O\: I c PAROXYSMAL RAPID RATE ATRIAL FIBRILLATION\ ii, \� ✓�\\� 6 MONTHS F�2 LneA En.erTyeUndalyepCause(DiseaseOrIppsyThatlntaed j % 11 °�`� BSON''COUNTY AUDITOR l
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f1 CHRONIC OBSTRUCTNE PULMONARY DISEASE,SLEEP APNEA � / .Il�� _hl � 1vr�i�a rya � �i li lire in.' , Yes �No/
iA v 31^Da Toba.Use C«adee To DesTO.. 92 I1Periale���,1J ��t'\�� ' ,A��,1 33 HamerOl te:,'a� AVIe `� .n�
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fig ai.Signature Of Penn Certrycq Cause O Der't 1.I,c.//14 ,11i`%ram /1111 f/ .II9 -kmllf az Cera1(Chee,atyole)''/ ;1t11 /// r' t 'L_ ".
�, WILLIAM R-WELLS; BY.ELECTRONIC'.SIGNATURE v ‘4 all%tv r - ! 4 d 1 .0:Ced.Mnp Ptysaen 1t tO C«me'i11I ❑,Hesel Orem 1 •
j ��.43y Name:Address/vet rap Code Of Person PA- i1L(ertiving Cause},AA,�11 LiVVv �w��I{(L � {V��,o �� lit K- nbe ) +s��ewa.
�P 1,1 WILLIAM:R WELLSft510.NORTH-MAIN STREET, PRINCETON,iIN.47670i11 U. •11 iL��it1 � 01017790A iiiG/ 1 ,0724/2019,
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Sue Fain 53395 ATTENTION ESTATE The Soda)Sewny a is being requested by this state agency in cider to pursue responslbJdy:-Dis'tlosure n voluntary and then wM be no penalty fa re'usal 2�
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t' { •ORIGINAL DOCUMENT HAS A MULTICOLORED BACKGROUND ON SPECIAL WHITE SECURITY PAPER ARO THE GREAT;SEAL OF,THE STATE OF INDIANA ON BACK THAT •
@j��WARN I NG if TURNSFROM ORANGE.TO.YELI.OW WHEN RUBBED_ORIGINAL_OOCUMEN7 HAS A HIDDEN VOID_ON FRONT THAT APPEARS WHEN PHOTOCOPIED. .. /et 0III