Death Certificate - Silkey, Sandra_10/22/2019 •
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.. INDIANA STATE DEPARTMENT OF HEALTHY s 6,t ;•
CERTIFICATE OF DEATH
( ` . Local No Q00043 EDR No 000000625782 2.Sex State TM"�« ,6_$/1[.QD,,; o r• .•1 `° j
l ,�, 1e maiden Nang(IfNmar) s �,. �y '. �,A.l ,y
•
YOUNG
LT 11.ceordents LIDO Nan.(FkK Allddr,lase ,.s
FEMALE 10:45 PM ' 0210 62�I S tot
t 1SANDRA LU SILKEY
'1. 5 Soaal Sea,my Numbr,ea ADe-Th. 1 et,meow 1 Yee 90 Under 1 Month ee ndsr 1 Day es.Under 1 Hour 7 Den of Hirer(Mon&VD•Yr4.1 e.eelhPfece ee el". ..". ee�!T ,.'2 r tag t '
`C I Roos Wises
10 il Deem Orx1x� p ❑Hospice Facillry ❑Dederlera'•Horne ❑Nurs•q
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❑Yea ®No ❑Unknown ®Irtpeaera❑Errargplcy DoPM^'.m Oupe5e 0Deed on A+nvle ❑Od'e($Der]ly)
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11.Ninety Name(II Not Insinnon,Gh•Street and Number) ll •:F
GGIBSON GENERAL HOSPITAL 13 coumrD(Dasrn 14. marital slaasNT4ne«D..e, �(l
12 Crty Or Tour,State.Are Lip Coda Married❑Menled But Separated ❑blwT ed e 1`'
O Yddoned ❑Never Mantel, 0.Unknown t
PRINCETON,IN,47670 GIBBON' ,;, aeolal tale 0uaay i {�
15.Surviving Spouse's Ne'�a
15a.Lest Ngme Before First Wimp* 1e.pacsderll•U><nl Ocu+PWon
'JOE FLOYD SILKEY REGISTERED NURSE HEALTHCARE
l.( 18 R•aldenea•Stan lea. County I , , 18b. City Or Town i I
• INDIANA GIBSON PRINCETON tee ApLNa 18a.2pCode ,81. InskeGgLmus? i)
I t)tl Street And Numbs� I ®Yes ❑Na 1
1902 KEYSTONE DRIVE 47670 1, �,
(., . 19 Decedent's Eduraton 20.Decedent Of Hispanic Ongin , 21.Decedents Race 1
MASTERS DEGREE(MA,MS,MENG, NOT HISPANIC White
r MED.MSW,MBA) zee.Pa enrs Leal Na M IBerora FvatMe Sspe '1
�( 22.Front's Name(First,M.dtl,e,Laa)
23.Parent's Name(First,Middle,Last) /!'
t WILLARD ALBERT YOUNG EMMA BEATRICE HERRIN PAVEY *%,
/ 24 Intom'ants Name 24a.Rde9onstip To Decadent -24b.Mailing Address(Street And Number,City,State,by Code) Q
liI JOHN SILKEY SON 10024 FOREST HILLS ROAD,CALEDONIA,WI 53108 0
a
< 25 Place Of I:muesliwn
25a.CC Method Of Dispos,am 256.Piece Of Dispovtlon(Name Of Cemetery,Crematory,•;11Mr Plata) 25t.Locatlon-City,Town,And Slate D
111 DigBurial IDCremation ❑Donation CIEntombment r
Cg cc CI Removal( pecIfy) to WALNUT HILL FORT BRANCH,IN M O 0 Was (Specify). 27a. Funeral Home License Number
• ♦ I ZB.Was Coroner Contacted? 27.Name And Complete Address Of Funeral Fea::ty m
W FH83005671 0
W 0 Yes ®No COLVIN FUNERAL HOME INC,425 N MAIN ST.,PRINCETON,IN 47670
27b. SWratera 01 Indiana Funeral Service Ucensae: 27c License Ntmber(Of Licensee):
i. 0
J MARK R.WALTER,BY ELECTRONIC SIGNATURE FD01013010
a Cause Of Death (See Instructions And Examples) I Approximate XI
11A
Interval' Onset 33
I: 28.Pan I.Enter-The Chain Of Events-Diseases,Injuries,Or Cotnplioedmis-That Directly Caused The Death.Do Not Enter Terminal Ev r To Death D
/r G Such As Cardiac Arrest,Respceary Arrest,Or Vontrrcular Fibnllabon W ul Showing The ETalogy.Do Not Abbreviate.Enter Only One Ce O
.i r O A line.Acid Add,tlonal Lutes It Necessary. m
Immediate Cauae(Final Disease Or Condition Resuthng In Death) A. CARDIOPULMONARY ARREST MINUTES 20/
Cue b ra•A.ACarsan�.4 •-
7. Sequentra ly List Concitions, H Any,Leading To The Cause Listed On B. HYPEROSMOTIC NONKETOTIC DIABETIC COMA UCT 2 2 2019 DAYS.,
That In n+a rc, o'x �T)
Lure A Enter The Underlying Cause(Disease Or Injury sL�',
The Events Reu!lmg In Oeah1 Last C. a a(o.A.•dma.a,.o ob
l///` D• l/1}j� Aj '9
.! Y Fart!I.Enter OthrSlmfcant Gond-ova a Coembuano to Death But Not Resod In The Under-tying Cs.se Given In Pat 1 29.Was An Autopsy FerrmQAors•1r,f C� ®m No 7 •-,��`I
r 30.Wen Au:.. Iii•'le le•(Y`.LJprf LeR ❑Yes ❑No jil(
( BILATERAL SU804RAL HEMATOMA ASTHMA OLD AGE 33.M•rrrsr Of Death.
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! 31 Did-foto=Use Contribute To Cent? 32.nFerrate.
❑ed F'•e'•.avp'Yrvar ❑r'.'°Ar*'-ao.° ❑rer P'.pn.'....11 pr....M r]On*ao.w. ®Natural❑Horn-tide 0 Accident 0 Pendeq.IrrvesegFtAn 5.
❑Yes ❑Moberly CI No®U^u'w^I ❑...eel ovn+awaOomToltirMMDs. ❑ r�nnp..wer .P.evw ❑Sumtle❑Co tlHMBa Oeemvned • 1 r
�y 4I (1.5 Brno Of Injury 39.Pecs Or Injury(0,0..Decaeonts Home•Conetrucbon Sea,Restalrnt.Wooded Arse) 3?. INroy A:Woo? :�
>,.Dar«1n,uy lMonnYpeyhsat) 4
❑Yes ❑No
• 3e.Locatlon Of try W-Si-me 3es.City Or Tout aft.Stoats Numbs Sec.Apt No. 3S Zip Cede T
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r •1 flgrol ue,Of Parson C&'•Mv Casa Ot Ouch 42.CertlSe(ChrA Only OM) -
RAMESHBHAI P PATEL`St'ELECTRONIC SIGNATURE El CerdryIng_Per en 0 Coroner CI Heelet Ofscar - �
( 43. ems.Abbess Are by CO<w«Parem Capa.'i9 GUN«Dealt 44. Uc.nas Numb. 45.bale Certified -. r(
t t 01040266A 02/08/2018 r�
RAMESHBHAI P PATEL 685 VAIL ST,.?RINCETON,IN 47670L.
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3 3' 7 ( BRUCE BRINK JR V'i_ iECTRONiC SIGNATURE FEB 09 2018 1 `� �
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