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Death Certificate_Luttrell Sr . .. •"'.:2,,,-',1:1".-_-r":":.--5:„.:-;_;',"/...":',:::,;:"-:f'.'".:-."n:-.'.';.;•:;•.',---..•-------:'''s.-: i-,...-..:-:`,1-:,::;'.':"':._•.,',.5-:‘-.•- •,'-n:.:":: ::•;,11[;";::;'.-,:.7.;-;'"":"::;--;--',-,-;":".::'",:'..-.-,-.._...,":'.',.';`,>••,'•: :•••,72:,...:.:-,2,-;- ::-,-;-,..:::;::,_^:,'',---,:'•7-'::;-':':,,-,:.,),-,.,- .,,,' „Pp‘'::,:"V -;-T•!::2-di{:-.;3 ,7.;,‘ .. , ,r1001A.04:;$.:(4010ep-AkzileTN+. ,--,,......,.. ...-%••••-i i f- ----is.-it,1!r.,..-•-''.,.., ••-••.<:•,-,-.:;..-•:,--,';, ,,''''"•f...-: '"•=f,1:.•'-':--',:'';'.-;"‘-; -..";;;S-'.',1;t:'•;••7•-"-15:-•c-':::•-••••••i 1 ' 6-t.f-rEALTH : -'-':-.'-',,---''.; ---.r2,--,..;. -. -.4:-..- : .,.n.,.'i--.--,1--,AT.--;-:: :-.:.1 - .-.--'...:-',,I.:-.- -...:- .:.--.-::- .EktiFf.0-A7.r.g-0E1DEAT.H:1-1:-.:-:'':-:•:::::,,-:--..-.- -'•'.-.• .----!1-c. . . :. .$. ;Neer,,,-.,..-,- ..;,,;-.7•. y.-;.,. . .':-,:----;,.•'-., •... :: .,-..- 1 ,,:.,, ,c,;---,-.::-,11:rri:::::::::,11 ,,,:-::•:. .:W,-._"--,:, ;1'1,-;',•;-1;17,`,::--- -%,-- --'', : .--:ii'.y::::.-' • -"r:::.',:'.g'-.',--,-;::::-:, '' -:::-.--: ; .:-.?,-.-- , ,•,.!. .,-, ....! •......•-•......:. .,• ... , ..-.. ;,:..s...,,,,..: .-_-•-_,•:!•.„---, ;,----,!:•,:: ;;;,.. -.-,;1 ,.'' ,,,,. ;. ••:,,„. ,,_.- •.:_. ...-:;;. . :2:::•,:-.Z;;;,:::•-.'f; .;. •.Z.7:'4.-kI*20'..:'..•:-;1'1::izob4rN-oi:000:952:, ',.. - , .: '., tbwgeil000000384942'- --:' :: ' Staid..Net'0 2-1:841-f'-`-'-'''''"••=':- ;'':''- •'' . _ . . ..:'11Rac05nya.t.p-galriKfirat:WIFF15tla,Lastyl:.1::::! ::::::.);•5,"• ..,•-.,_. ;;„):•,-;:-.;..., • -14.?Maldep.Name(ifIP5PFK: =.;:l,Ci.::•r- .•4 l'-..2,Sex... .3:,Tirrie Of Death; ,?.4:::.Date5Of Daath-(Mcintri/Dayiyleary.l2.:-. ROBETRTG.LUTTRELL Sr:. , . '.. ':: -; -: !? ; .* -i:: ' .i-:' :.':' '''',, ...•.-:.'--'..'.-.. ';-.: `;':..'..'.. i.MALE '--.. 10:00"-At ''% .-:.::-.? V. OS/if/2014'1 5.-::SociallSectiity Number 6a...Age-Yrs. 6b. tinder 1 Year 6c..Under 1 Month.-.651.-jl.lndar T,Day Be. tinder l'Hotir; 7.'Date of Birth (??litinth/DayNear) 8:Birthplace,(City and State or ForeigniCountry) .,• •, , _,---.=- " • ' ., : f.- ': : • l -.. , - • .„, . , ,. , .. .. . , . , .- ,, ... , , . • . • , Forces? ' 10..if Death Occurred In A Hospital: . •' ••, ....,. . 10a. If Death Occurred Somewhere Other Than A Hospital - , ••,...:•, .„ .. . • ; - ,,• • :' ' ''.- •' ... 1:81 HoiPiPe Facility'' 0 Decedent's Home 0 Nursing Horrieng-terrri Care Facility' ` : • .„, . . . , El Yes -.El No ,EI Unknown.. 0 Inpatient El Emergency Department Outpatient E Dead on Arrvat L'Other(Specify) . ., .. • .11). Facility Name(If Not Institution,Give Street and Number) . ., , .., CHARLIER HOSPICE CENTER . . . . , .. • . • : • . , - • . - . . , , . , 12.City Or Town,State,And Zip Code , , . • 13. County Of Death . 14. Marital Status At Time Ot Death ., . EV • , ti7 MarriedO MarrieCtsBut Separated.0 Divorced ANSVILLE, IN,47713 , . VANDERBURGH Ei Widowed 'El Never Married ,Ej Unknown 15. Survi,Ang Spouse's Name ' 15a. (If Wife)Give Maiden Last Name ' ..= - 16.,Decedent's Usual Occupation : 17. Kind Of Business/Industry • . . ' . HELEN LUTTRELL : . . WILLIAMS . :. . .. , . AUTOMOTIVE. : AUTO ' .18iFtesidence-State- • 18a. County - ' lab. City Or Town '• ' . . • , . . . . • . ,.,.• , „,, • ..., . . . . , . „. „ .. .INDIANA . . . . ,. . GIBSON . .. .: .. PATOKA „ • , • „. . ;18c.,Street And Number '• . . . . 18d.Apt.No. . 18e. Zip Code 18f, Inside City Limits? . . . ,. . . , . , . • . IEI , 203 EAST STREET , . , : ' • • , , . 47666 0 No ..... . , . . . 10,:f.,Decedentis Education -: ,' I 20. Decedent Of Hispanic Origin ' • 21. Decedeno-Race ''. .1 - ' -- ''''. .., . . •,, . - :•,-. iiiari SCHOOLGRJ;;DUATE OR.SED,' .. . ,.• ....,,,. . ...... -•. , COMPLETED .. - , '.: . . • NOT HISPANIC 1 • - '.. : I.Wliite . . . . . • . , „ . . , ., 22,Father's Name(First,Middle,Last) .• • 23,Mother's Name(First Middle,Last) , 23a..Mother's Maiden Last Name '`.; ;! .• . . , . . , • • .. . . • . • . , . . • . , . HORACE K LUTTRELL . . . . •. DOROTHY'LUTTRELL , , . SUMMERS . . . - , ; ••••. . 24Inforr1anes Name .' ` . 24a.Relationship To Decedent ' 24b.Mailing Address (Street And Number,City,State,Zip Code) . • • , ... .. ,• • , .. - .. . . ,:.,- .:. , ,..• . , ALBERT F.LUTTRELL • . . SON .. . :: , 110 EAST VINE STREET, PATOKA, IN 47666 . . . .„ . .. . , ., .,. -.. , . • . .: •-25:Place Of Dispositi ••cin • , .• .• . - ' ' 'i '• •25a.Method Of Disposition i ' • . 25b.Place Of Disposition(Name Of Cemetery,,Crematpry,Other Place) , 25c:Location-City,Town,And State ,_ . • : ; • • • . : . . , 8 B6rio a Cremation El Donation El Entombment • • . . : . . .• - ' , - - .. ., „• . , . • : •.s. ‘ .- ID:Removal From State . . . , . EI,Other(Specify):',-. , '. OAK HILL CEMETERY,:: . ;• . . „ .', :. PATOKA, IN -• . . • .. . . . . ., :26..wasCoroner contaqted7•., • 27%,NanteAnd Complete Address Of Funeral Facility ,.-,,. . . '• .. .,,. •, „ . , 27a. Funeral Home License Number. • - . • . , , • . . . . . • ,• , . .. • • . . . ••.,0 Yes 121 No . , .. . ' . • •,,,,,-.. :•.' ,.. '.:. .•• . .Lf COLVIN FUNERAL HOME INC,'425 N MAIN St, PRINCETON, IN 47670 • . . „. ' FH83005671'27b. Signature Of Indiana Funeral Servicelicensee:. . ' . •,. , 27c. License Number(Of Licensee): . " RICHARD DEAN HICKROD., BY'ELECTRONIC SIGNATURE : • ..• . . ,. FD01.0.12153 . „ „;‘,... .„.,.. .... • , . - „ •:.Cause Of Death (See Instructions'And.Examplea)' ... . . . • - ... Approximate.• -•..,.., .. , • . , 28.PartL Enter The Chain Of Events.-Diseases Injuries;Or Complications-That Directly Caused The Death.Do Not Enter Terminal Events . . Interval: Onset . ''•, . Such As Cardiac Arrest Respiratory Arrest Or Ventricular'Fibrillation Without Showing The Etiology.Do Not Abbrevidte.Enter Only One Cause On . To Death .,A Line. Add Additinal Lines If Necessary: . . , , . • • • • : . : . . . ,. • , . . . . . imniediatetause(Final Disbaie Or COndition Resulting In Death) . A. C140LANGIOCARCINOMA • . • 6 WEEKS • . . . ro(Or As A Consequence 09: - • .• . , . .. . . , . . . . . „ • . , • . . . . .. . • Sequentially List Conditions, If Any,-,Leading To The Cause Listed On • 13. . •• 2 ,. Me to tOr As A Consequence 01): . , Line A. Enter The Underlyigg.Cause(Disease Or Injury That Initiated The Events Resulting Ini Death)Last : • C. . '' . '• '. . - . . .. : .Due lo(Or As A Consequence 00: . .: • • . • . . . • . , . .. . . , . . - .. ,.` '. . .. D. . . .• ..Part ILEnter Other acrificant Conditions Contributinti lc:Dee:12 But Nat Resulting In The Underlying Cause Givin,In Part I ,. ,, 29. Was An Autopsy Performed? • , .,:- : . 30. Were Autopsy Finding Available To Complete The Cause Of Death?, : . sEiYes it No NONE -- -..• . • . . .' 81. Did Tobacco ti,ie Contribute To Dool,!7, 32 If F,'tele: •.. .-a • • . '33.Manner Cf Death; . • , . . . . -. • • . . . • 0 . . .tiit Fr4nantWthin P„nlYear D i=iinpiirilatn ,•o..! •.ot!rep,..1Pre. : 2 Days 010eallt isj Natural El Homicide••El Accident 0 Pending Investigation. 0 Yes 0 Probohly121 No 0 Unknown 0 Not Plea...ant.Oct Pregnant 43 Day.To 1 yean•Bero • th C't.r-.."7 •'• ..r t• .:..tt-ea year 0 Suicide 0 Could Not Be Determined - , l • .'. 34.,Dale Of Injury(Month/Day/Year) 35.Time Of Injury 36. Place Otinjury(E.G.,Decedent's Home,Construction Site,Restaurant,Wooded Area) .37. Injury At Work? •• ... „., ,s.:„., .•, . , . . . . FEB 2-6 2020 . . 0 Yes 0 No"'. 38. Location Of Injury-State,.• -4 38e. City Or Town 38b. Streete lumber • ' 38c. Apt.No. 38d. Zip Code ' • , . .,.- . • . s , . 39-Describe How Injury Occurred , . " )011- 6117441 GI B$O TY AU R 40.If Transportation Injury,Apecifyr. • OOnvet/Operator OPasserger LiPechstran 00Ther(Spectig) N COUNDITO ..„ 41. Signature, Of Person Certifying Cause Of Death: . -• , • 42. Certifier(Check Only OneOne): , '. ,.. ,..., . PATRICK C. FLAMION, BY-ELECTRONIC SIGNATURE -. • ... • ''. - 1:0 Certifying Physician . 0 Coroner : El Heath Officer 43:-Name,Address And Zip Code Of Person CertifyingCause Of Death: ' 44. License Number 45. Date Certified, . . , , . • , . , , . . . . PATRICK C. FLAMION , 801 ST. MARYS DRIVE 4 110 EAST, EVANSVILLE, IN 47714 01027520A - - . 05/14/2014 , 4p.,Adcritional,Funerel Service Provider.,, :.- , .. . . „ . 47.:'Akas: . • , 48-•Signature of,Local Health Officer 1. •• ... r' - ' . ' •;- : .;; •. • -. l ' ;;. -' 49."For Registrar Only -Date Piled(Month/Dayty,ear): "..., .. ', l: 5 •-•,„ •, ',. , • - : ROBERTKENNETH SPEAR,VIA ELECTRONIC SIGNATURE, .". .„ :.: . ;.., • : : , ., '.:- ;, ':'MAY 1620.14 ... - ':j. .1 L • . '..•-:,. .....--::., ..::-.- . .,... .i- .,..... :,. !. - , ... AMENDMENT-TC CEF2TIFICATE.PF DETI-f(ENTFVFORORIGINAL).. '•;•i j. .:.,' si. ':,. ':',.?''.' '.::.,,-...,. 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