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Death Certificate - Rodgers, Curtis_9/19/2019 tr:-' „. ,..t.„,":' ,. „......,. .,..!.-„„ ....„. *-t•;_.-..„. . •.,r,_' -• . ,- . •- - - ••' •-•./•••• •".ii) ..4.., -'.., - I: 2,)/ 14,--9; 1:4 51i-IL.-'./',I.-, a+)•.ri-r, .-. -,,f .\----,,,,11 , ,p; --.1:-.---'-:,,. INDIANA STATEDE,P-• •TMEN VU17 rlitAIL 1 14 •-‘,--"i:;••':-,---;11)-1::•-..,-...; !•..---..-. (rc-.-,:. ,•-•.--.••.--. , i:-.,...--.,i,-?,. .., .. . 'I .-I'-'I 1 L":','J fz- ' • '', ' ' '' Vef....,,..,,, ---:-. 1;-f.„'•::',-,11.:!'',2f:‘' :1'.:<'(-' kr---',.•:.,_; j C.'..-.-,.)-t.zriz.--"...-..;,,,,....-.,...i,,,,.,..,,„„_,...3.. ,,....,,, ,.:„..,,,,i ,,,,..„,,,,,, It. t, .. -,;;11W,;..;i,It j....::::..,-...1 d 5„:-.:::,.:sji if,•;...:fdf 1 1 ii:C;;;•_::i i.fg.:_,`.•`" --: ' ':'•'-';':4,•,:".-0.`''.r.1•:--.-S '..rS:-'' 'z.V''''S.:.'4'..::-'-' 3"=•.."--''''-..,.'- ',==.= • :, . ,, ERTIF,ICAT_E ;DEATH 1 .--<-:.=•,„ "..-1:1, ,,,,,-(----1-,-,-<?.-::;----?....„1-1.Y-...*":..!, ..L._,,' ''.:-,4-...--,, ,40‹,_,.•-.;-' it --‹ -fs.E,--r ..:..,....,;;; r,.;,:-...„--,::.,fp,--,-10-.2-2:iN:,..j;,;2,-,„:-,;;;:•;:f;‘,-;;:,--.D5-...t,T),--z-.›.,1";.•.'',=%."-:-1'":"•••:c.i--':,..•i=',.-:-.-..i:?..S,-.•,"j'i:' :.,...;,„..'-" ,....-:>,i::),•:',.=,-_,..4‘,''..".,1'''..1-:,;-','. • c,. • 1",,..,._3 i,. ...."• • l',....%.i.11C,2;c:11M-'2..: 1,,,,,.:2.:11%if..-;-jr- ,..:,,•:. ,,,,..-_ 17,./...--,-'. .r..-2-, ,,r .:-...E.--ui;;;-:•,•:,,Ii{..:::.--.,,..?! . I p:.:.:;;;., 6i--1...::-...,s -• ::::::-...--:_z..-z:-N . 0 . . -.- ' -' 7-:.--( 2.„-:41,;./:•:.:::_ Statelklo 000236'-''''-"-------Ei5k14' 1'0,0000.054.883'' ' ' '' ''. ' '---• ' 06098.8.--141.!1;;.%j -,-,--'1'. -,A,-,.-;.„'2 iir6 __-,.....,;•:.''Oca .... 0.. , . •v;,- „c,Dece'clip Legal.Narn0;•(F,irsf:;/‘iftlStdra,Last).%,:;:i'll'!-;:';..--;',::,'';',-...5.?=,,'I':.='.",:----:Iii-/ ?:i .k.•-,i1;,..1%,'11/i4,51.•t,i4Illeu...(i..!-f.0,Tal°,)::;;;I 'i..:=';:- , .. ,2,Se - `;'i:-;_•;;•,"?trjr,...s,9fIro,.6,?Lt3.-;,11 ,,:---..-`„4,J,c,:r.:9!:.Cle,--Iti-jit,:199111PY,,,,„,. ,,':-;:":•-- .,j-_.f,:- i':,,., r'r----,..::, . 1-',--:-.--''''s_i t:-..<7-1-ii-.!----,c:i':',.I%-:-.:',..U.'•';.--a-' :':-.'q; (=-:- 1`*•" ;:-5,- :"--,4i_1,1 f:-7..,,.g,,,i.i._,-;.; .,.‘ ! "‘' it-,_:.1.t.,,i,' ,..:-. ' ''..' .11 •,.,t 0 RTIS_WES 12EYiRODGERS‘'. .:. !: ;•-•:.:. "::'';''.":-1,3'4::.',.."'•;.:2:.'.:(-,. ....::..3• I.L.Z.:":•.-;•-•'..'••••Z .:• ,''',i':'::::-.:.\':::'''. ::"::•.-..•,-‘-- :-..".‘•,.:".• ': rviAL 5 '--:',• :,,A.)L1 0.P nn.s.":"--;:- ..-:::::z-z...; z:1.2/.16/2016/.....:,;: ?.:(:, / , , 5-:Social Security Number Se Age-.Yrs i 6b:Under 1 Year Sc.'Under 1 Month'ficl. Under 1 Day,:'.:'tile Under 1 Hour ;7 Date of Birth:(Montn/DayNear)--: j8,SildhplaCe4City and,Slate or Forelgn.Country)-;;,.-_:-...:.•'' .-: •,.. . ,.. : ' ... :. i . . '.;% ,...--';., ...:,1k: ::?,''':.Z •‘- ... , Hespital.:::: ,.--:: t:-.'...-',.' ''re'' '..;i'-';:::-. •:;:,'•••':--. ,_ .:...,:it':::..;••• -1 . -..',..2,. ..:„,,,..... :,:':.:-..:-,:.2,t;:; -,..::. , ...": :.. •:: -,,.,:...,,'.... 1',-;.s.:;,•,. -.-,e,ki,-,z1,...'- ',....,,:-.;-','. ET Iti?/?..4F,i.ii_v-...'Igl Decelleritpt.ipme,(tp Nursing i-lomeiLiFfig-....ierrn\CareFacitity ' :-:.,:,... /.2 13? .Y4 Igl N0 ID'.. ,ir<h9w0,. Elyillatilntf.p'rj.i.ergenCi Efepartin'entsOutp?tien't...::0/P :,1,?!."..':''''Srri`..?!:'if pliiii`eisiik.ify). ... -;-7., , ..,',,---,-, :-.... .-- ,,...--,...--,-.=--.....:-3,,--•-....----!--...,;....,......,..i,i -=.‘....:-•11,•-4-;---::•:';':'''-::.::‘..i „.. ('' ' 11. Facility Name(If Not Institution,Give Street and Number) . ' , • : ''3;-,-•,:.;•:-1 ( ,-`,.", I'='•.,NI --,'-_, -..--'.. -• %."-,•.-, ',.: ' • • ' r 202.SOUTH WEST STREET' '• •',• . .- • 6 -• ::..' :-: 1 ,--.. . -:... ,-;••.:.• .- •,..... •: • '12. City Or Town,'State,And Zip Code ' 13.',County Of Death ,- ' ' 14. Marital Status At TimeOf Death ' ' • .': ' ' ='' •• ' ' . . • El F,+1 ini e d ID Mahied,But Separated;n Divorced . . . ,?s,'• PATOKA, IN,47666 . " • . • • • , 7:'.:.„ ,.. .;.;'••• GIBSON • ','• „. El Wdowed •El Naver kanied ,.=CI Unknown ,• , (.4, 15.Surviving Spouse's Name • .' - • , . - 15a.Last Name Before First Marriage :. , ' , ,,-16. Decedents Usual Occupation •• • - 17. Kind Of BusinessAndustry.;- ..,. . ,,.. 'z- • . , , . ,, ...,.. ... . ,JOYCE LEE RODGERS .• . . , , SIMMONS ; .•, .• -.. . . . CARPENTER - . :. " CONSTRUCTION .:, _ - 1 ,. \8. Residence-.State . --' 2. '_• - - ,."., ' , 18a. County '; • .• ,- ;.:' .-.•lab.City Town . --r.' '-'.- . ',,-:. • ' •"`-' '• ,'' -'• ' I • ' '- -'-': ' '' - I ..-"--' i I /:'.'.• ---,-1' ' ;•-'i ' '''• '.••.--•• ,. . . .• ., ... '. -- .- ,:-.-.•'r ', ,.. ' 4 INDIANA ,.,,-,;:, ,• -,- .:z.1. .:„Ii,- -.. GIBSON •;.. .:.2:, :. •.. -,,-:-, ,.,;-. PATOKA' .•..„'.'•• , '---,, 18c. Street And Number., •• , - ......,. •., -:" _ -- •...,. •• ••• ..-••‘,s. ...." - ..:-. - - •', ; ' . - ' •18d. Apt po.':' -- %15e.Zip Code-..,-,.' 18(clnside-CitY Llit,tits,?-= O ....„-6 ....-, •, .. . , . . . , ' ':' • % --.., , -: • , : • : ' -TZ.Yes El No 1)..., 202 SOUTH WEST STREET . . ' • . - .-. • •: :'• • = ' - .. '--f• ••- • '. . - :- ..... :47666: ...-,••-,..."'-`-',_'-.::-•::,..::•••:.-`,-,.. -...,' • , ,19. Decedents Education .• ,- .''•;•=.;.,•, .•" • 20..-9pcedent0f Hispanic Origin . ' ; -',-„' "21./Decedent's,Race: s., . . ,, . • „..- . •- .:.,' , ' . _ .' 6TH GRADE OR LESS ...'.'--._. '.,• ' NOT HISPANIC-.;-:,' '.,••••••.'''... ., --....'..' '. White.-..'.i: •.-..•, ' --- 22.Parents Name(First Middle Last)J'; I: . ; - .. ''/ •,' ,.::- ...i•;-, =.:,,•' •."; ';': ,23.-Parents Name(First Middle,Last) ' •• ..' ' -23a.Parent's Last Name Before FirstManiage, ' , ' -, -. ...i •.':''-', '-`.•:.';';',":" '_•'-'<-i,l .-.-. '•.•--., --- •=a, ".1-...: ':•.. -r.'i'• ' ,-.;.-'•:-'=",'':..,_`•"=',.',"‘,--':.•-' ..:-... -4- ••-....,..: :' 'z'''' -1.''-',.- ,-',.=-.,:::',- I. '..,-' -:• .-- ; iNILLIAM RODGERS•', :::: .:- r.,";:', , i'•>:. , - •,DEI:2LAIiMAY.RODGERS.:.1:1.---..••, l'...;:••••:',.•!‘:-..-•• JOHNSON ,'.•-•,,'-..,.• .,....:.", '',. ,...- ', n>. 24.Informant's Name'-...,,." '.....-...-,.';- 2•.' , 24a.Relationship To Decedent-',;;;-•,: 24b;•Mailing Address(Street And Number,City,'State,Zip Code)/ •;'-'..?' ;''. „•:--•.---...: ••-.e ' , ,..,• ' :.•, -'-':, Z.: ':.-'''',:i;-=!.'`''''' ' . I" • JOYCE LEE RODGERS'..,: -."- . ... WIFE :.'-• • . : .: ,.. •-...., ,:'. 202 SOUTHWEST-STREET, PATORA,;;IN,47666 L..-- ..-:., ;: .-" ' .. : ' • : .... 25a.Method Of Disposition•;.....:::-.--; :-.'„•:,-'i i- ; ,- 25b.Place Of Disposition(Name Of CametarYCrernatery,pther.place)',..'25p.Location'-City Town And State':,si.".::.it•;•-.2".-.!'.'• . - • .--;•".-' -.'., '...;-•:',•.. ` a El Stria! EI Cremation,D Oonaticin'El Entombment . . .• •. . .,-,,. , . „ •- ,. ... •.. . . (.3 Other(SpecifY): .'.-• 1:: ,',; ..,. . . . EVANSVIL:LE,CREMATORY.=-. .. ' .. .',.,.-.ir.•:. EVA , ,.• • -... ,. . ...„- ,,, . ,,-.•- -.•.., .-.,. .:, .-,.r. ...,... 27e..Fraral Home License Njrnbeit.. . , . • 25.Was Coroner Contacted?.-,'• .,. • 27. Name Arid Complete Address Of Funeral Va...., . „., -• .„. , ,., . . ' ',• ., .•'.. . •'• , .•;,' i'=',''''.';.'i';',.:'..- '‘','''..,''-',f -:-'-'; •.r'' . :-• .2•.:,;.'_.,-%""2-::::/' ;---/-, -•• '.".. : . '. : IZ Yes El No : : ,:.•.: 'H. .• '• --..' • 7: . ,-.-•:.!, ..,- . . '. :'.. -..::-..' -6-,- DOYLE FUNERAL HOME,!620.-S MAIN ST, F...14INCETON: IN 47670- . ,I :-. ,..!:..--,...: ! ::----; EH10400010 if 27b. Signature Of Indiana Funeral Service Licensed: ' - .- : • --' ''';' :.••' -,'"-=' •":,-,- , - , . 27c. LIcense umber Of Licensee):--.Y..--.---,..-:• -..'..- '. --`•=1 ..',.: • - ; BARRETT VV. DOYLE";,..2BY'ELECTRONIC SIGNATURE.;'. :' • ..,;!;.--•.;;;;:...:•:-,: ;.,. "... .:',i --.. ..'•... - ' ' .SETP5DC10090195---"'-'' ";:''''';'----:':.; ...."=-- . ::;,..:;: ..r" - `• --''-.' - '''',-•.-...`•.:.:-"•-,-.',Y,•:„,•''.-..----.': •• • : ..-.-. - ' -. '.., Cause Of Death,'(se(yinst4ictio-ns-And Exainples).-. Approsimte _A281.Jne Part. I.Entei The Chain Of Events -Diseases Injuries Or Complications That Directly Caused The Death.Do Not Enter Terminal Events .,. ' .':'2 `, . ' '.: 's.'. '- , Interval::Onset ••Such As Cardiac Arrest'Respitatoi-y-ArieSt,Or yentriCtilirFibtilletion WitpoUtSh-OV/ing The EtiolOgi.Do Not Abbreviate Enter Only One Ca On.:. • , - - , : • f., . To Death Add Additional Lines If NeceSsaty..:,-'- ' ", .: ,--..:.-, :..-..'-. '!. ,; .:.. •-'-';,,..`-',2„-..-, .-,(':1:--. -I, /*:-.•2.- ".,.- •- ." .-... . '.-. ' • • ' Immediate Cause(Final Disease Or Condition Resulting In Death) . A. TOBACCO ABUSE"..-". : •2..-.:.-.'--:r.-',...•:,..,..... in,.„,...,.. -- .,,, ,...,-,..,...I DECADES • ' NT?' " '' --.--.,•_:•• .•:, „.-....,,, ,..,-.• ,. ......,,,, lkil.P16kNuAllite lati Li U...2 -AUDITOR., ., _ z .,- i. . Sequentially List Conditions;'If Any;ileading fo The Cause Listed On",.: ' LineA...Eri!er The Underlying Cause(Disease Or Inlay That Initiated 52-'I t :::..;•,, ,'.:-::.:•.' 1',:.• ': ?".','`'.'"!".9 1i'147°1' ':•'',..' • • '.."' '-''/':' : `..:' ; .- -The'Events14esuitirid.iriDeethj ifasi •'• '-.,.:-..'-,,-", . . , •, :. ..-. . ..,•- -'•'', ."-'--...• .., -., .• -•.! . • : ., . . _.; .. „ ... , :c, •.,_ „..; ,,_ .„ ...., ..„. ... ... ,. . , . .... • . . .... . - •--,-.. - , •-.C. •CHRONIC OBSTRUCTIVE PULMONARY DISEASE N:-.. '...s.‘.'-.,_ `• -, ..... ...:-. .- • ".•' .• .YRS... -.• .- a . . , . ' --• " " '%;.-."--. ... '-'-:;I -ii.% I;....-.• ' Dial a Pm":c"'n!.cf.".01), i''.•• D RESPIRATORY FAILURE HRS Part II.Enter Other Significant Conditions Contributina to Death But Not Resulting"In The Underlying Cause Given In Part I -' - ' 25„WasAn Autopsy Performed?;,- '; ,..„,:b.--...,,1-:-6't-]' • .-'',"•,---,,.....':,.:',.:,:,,•' . -' . .-_ ,. .......•• •-.-• ., .; : . . • ,.,..- .-.--', • .-:'• . ' • s ,'',.• :..,-,'• , .',4. -•'.:'"".' 30 Mere Autopsy Finding Available To Complete'The Cause Of Death? • "' ..,.; DEBILITY FROM PREVIOUS' bEREBRAL VASCULAR'4CCIbENT.' ' .-. :-... ''''......'-'-•-•-'6:-.-..:',--:_-:. .;' `;‘," '.'.-.:...'1..' .., ..?,--...,-:'- . :'..:•-..---.-....; -.........:.....,A;....,_:.-.:-..., -:....-. •-.,..-,..,.',.El Yes>EI No,.,.. 31. Did Tobacco Use Contribute TODeath?''-''•;':: 32. If Female:c•' '-" '.-'.•' .•=';'::::": i'i '::•••'''..' ''- =-•.==-: ' ''.,=-:"••%. i....:-; .-- ' 33..,Manner Of Death '.- '..";:. •:...:':-,'=",-.;-..:.,...-;7:--.i: '-..',"......• ;...' ,,.‘;.:,-% • ': '', ' ' '' "' : ... i i -D Not Oriii.nt we. k.qTaar CI i,rigniriArrimidr o:;,:u,•D tiiiii.ei.Vorit,'do priiiniili%ye*.-12 Days Ofbt;It. El Natural El Homicide,b Accident f.EI Pending InvestigationYes 0 Probably 0 No 0 Unknown • . .„ ;El Na!PrApnant,Barlyrs pull 43 12y1,m i ywy efr«ii'D.111,.,:••.r.El-1.113yeri V Prop, (palm,The P.,,l'Amr,:,. ... El Suicide D Could Not Be petermined ...--,..... . ....."--. 34. Date injury(Month,Day/Year) ;' • ' ,35.Time Of Injury.•-• i" .'- 'l -;:. 36 Place Of Injury(E.G.,Decedent's Home Construction Site,Restaurant,Wooded Area)''.- p7,injury At Work? 1,g . .., . , ., ... ,,;. • . ' . . . . • ' • 38. Location Of Injury-"State t : ' - , : 38a. City Or Toym--j;:' :. :, " .-....:,.:.' ,381::Ei Street 8 Nurnber i --.., ' ' .' •'.-.-.- : 38c,Apt.Np. I', 38d. Zip Code ..1.-.•••-:"' - . • . .,--;„'I''. -.,%. r --. •,-": • •--,...: ;',".".-- v.::;. -.--_--- .---._ - - ,-.:' .>. . ... •:-.1•-. :------.„---,-.-;, 39. Describe How Injury Occurred ' '. )• "( ',","i ;' ',,',•':- "' .. •, 40.'If Transportation Injury,•ffecify:.:- .;;" '...;. . - F''- 41. Signature Of Person Certifying Cause Of Death:----. i.:...:-, :':-;."•l. ,..-.-,•:.; t...,-.'..i,i'i,. •••••:-: --;-: t.,.. ',•;;:.:-?, =- ''. 42. Certifier(Check Only One).---:".,' .'-.-. ' ' '.:--":"'•,'2 "'''' - ' '..- '• '..-'.5 .J C HRISTOPI4 ER'8ARTORE;:bY:ELECTIONFC:'SloisATURE:: ::,-.." -v.,----,:-..%-.-:::..2 :-..--/..-. . ..E81 CertifYindPhiSicieri..,•:,,EI:Ciii•Orie „':-Ij.Healtil Officer 43. Name Address And Zip Code Of Person Certifying Cause Of Death:i :`.1-, ' ';'•.- -... , :S•-' ' 7.-• -, "•:,' ' •?''',. : , '-'.- : :,- 44. License Number : ` • -, 45. Date Certified •... ' •", : ' ' , '; , • ' --', '.."' '' -'''•..'',! --::'i.•',--.:::•,' '.1 '..=--',:.,---.-','' . ' ..- .•„I"-• ' .,, ', ,J CH:RISV:OHLk-SAI:ktORE-1.70.-E.•:8-t A 71.-.:,-,EN/A118 Nili:CE,IN 1471-1 '.'..;..;-:.-...: --,---;.- . .-:/:- - - 0163776E1k,, :-:.-1,-- :' -.12/22/2016 '. . ..„ . -....;.. ':48.'/sdcritimal Flift5t51 Service p,rovider'•,,-..,,i'; -.--;:.'i;,','-'...'i 1,,1 i.•-•--;;;',,'.;'::::"1:-:l !j ..:-.. .1. i'.1,:=::.-:=..;;;,..i.l.','----;.i ;;"1: ':-,-i i.:„;,-, i•: -' :',:,.;, 17.,-!Al9s:' '•:::-.= ,,' =.. . :,.' i. .-• 48, Signature of Local Health Officer.: .....,:--.:::....--.!:...,7:-,.-......-;;?. . .1-,.-/:3,-..1,r,,,, , :; ‘ - - 6i- -;:...,,._.;.....t,',•49,...For.f.teoistrer:pniis-Daterjled..,.?,4plth/Day/y,,ar):: -'....:,,-.; :.•-,1',1. ..",i- 646 Ci-tiii‘if<jirks;'\iii1/4'.g(EOf kb Ni.6--. 16 i‘igrLikt,i.i I 1.:.i..t.;,.,..-'••••:',::., .1.:-.:-. V,ii'i,••-.-:?-.-<1,, :,---.,,,,'„' ".•:,.:;:,':.,: '.:-.--:-=.,:,. 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