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Death Certificate - Chavis, Barbara_9/25/2020 CERTIFIED COPY ISSUED BY ALLEN COUNTY • 31.6 4 6 0 � INDIANA STATE LLEPARTMENTQF HEALTH CERTIFICATE OF DEATH ' t..... 5 23 State No Local No 002457 EDR No 0000006 4 6 I.D4celenra Loyal Nemo(P.tot.Wad.LBWS In.Mellen Narita(If leene'e) 2.t'#ax 3, ima 01 COIL5 'll 4. 511Fe5l Main(t:3ranuayerean BARBARA J CHAVIS HARDIMAN ) FEMALE 03:06 PM l 07/0812018 `,)1Q aOcaal Conrad IOA Novae. Ilk UOaam OeaMaaE oaw'utaOmerRanAelWaaa- ❑)b Faddy t3-Dosedem't Name. ❑ I7udn3HaronoeVonn Caro Fadley ,awi a Yes 0 No Cl U'Ju a Inpafiax a Emorgan yOgYatvrl Ot4A rt 0 Dead enAraral o OYmr,(Spadta') .'11..FC A'Namb M N:tnanlla`.0.1 OreSuo oa')at and Nam : 3034 ABBOTT STREET . 13.��rr Of C,p, 14 Marital Elates Actano a Daai� . . . oz.Ct7 Cr Tox1>,SLara,Ar.J Ty Cade. Cl I„en{ndC atanhd.lMSegeratt Cl ONoroad �-y .. ALLEN a .Y!ovmd a Navarldmdad CI0ntraw FORT WAYNE,IN,46806 &i :.t) 15: u55*6 Sowers Nan, 154.Lau Nana 8ata.•a Ftu LSL111p. le,Oacaca1K5 Ususl Oooinaca IT.0so1 Dl attests 10050.nay ;; Z HOUSEKEEPER AND >. FACTORY HOME AND FACTORY - vi j 1a Ros%s c en:4-Stela 18a.Gordy tab.C`VOrTomo rx f N INDIANA ' - - ALLEN FORT WAYNE 1ea Pot N4 leaYt+Coda 1e1.IuiaGYlarST p lea szialAmN4nbar E Yea 0 No _ -' = 3034 ABBOTT STREET 48806 _ - [•-•.` 1y:C=dtm{Y Edugeear 20.Decrease 01 HN.paNa Otp n 21.Dea40M Rasa - C E tt1, BTH GRADE:OR LESS t NOT HISPANIC Black or African American '-, '•'71 ' 22.-Pawn,Neme(Fas1.1.03 e.Lau); 73.Paranrm Ncxm trim.'awe.Lute 23a.PENSIVE Last Name Ealarm Fait 1.tatrago = o OMA M.HARDIMAN MARSHALL ,• c = JOHN F.HARDIMAN • Z�c-L Z 4 24,InYcau30 Nat.! .'.. 244.Reseonitap To Demdira . 24t,M014,1 ee ;eta(Watt Ana Nunnor,.Day,Beata,Ap Coco) 2 ;?L SONDRA J SEGURA. •DAUGHTER' 3034 ABBOTT STREET,FORT WAYNE,IN 48808 -, ^N L - • - . ._,. .. 25.PlazaO)Dirt»t155n ,•' w!C 254.555212d Of Dtspo0eon 231.Ptoaa Of Oltpa3.l:en(Nemo 010emalcry.Cm mom.0005 Placa) 214 Leeson•0,ty,Tc+•n Md Poll CI ekal O Cramtlon O Dolugan0 Entombment C 0 ^(;_- Cl Raseval From Bt,lo • 3- EVANSVILLE CREMATORY EVANSVILLE,IN aYa FueenlNaneteeeni, aniu: 3 a,eow.l�=M Z --i- 2AWei Comm Oents=aa'a, 27.Hama AM template Ad3:eDS 01 Nasal Faa4ty - 1lizc f ••C a Yu a No COLVIN FUNERAL HOME INC,425 N MAIN ST.,PRINCETON,IN 47870 FH83005871 • O u_C- 21e.Leona Number(Pumping _ ... 270.a�pnatrcolalaanaFwrnLsanic.Lkar.aaa: FD01012153- . Z ' )Z` RICHARD DEAN HICKROD,BY-ELECTRONIC SIGNATURE < f - • Cause Of b th- o tnatroattona And Examples) Approximate Wannk:Onset tit T • f 20Pot?Erdeo'thof' tifFyp;,ug-DimeasOAtriRivalae.OrComptrationa-Thal ' CeucodThoDooat.CoNot555*1To7mtwlEv s Waive:' ; Soon As.CarcTnc Arrest,,Rotpaatoy Attest,OrVer..rhtdarFaxi2aton YPUlaut Shy ' Etbtopy.Do Nal Abbtuv4ta.Enter Only Ono Cot.4 On To°oath ? . c,:t ` ALna.lddAddaboatLb*:Ittlocotmy. • SYEAnS• 0•^ = linna:CatoCauao(FlitolDIsoaseOtCccodAlonRosu2lgInDeath) C:RE8ROVASCULM 1"EIVIS 11 J�t U 9; �` n = _ SOCpC UDIV Lig Ca4,3ca.U A-y.Lea** The Carta LIslad 0 awl,N,r.><w a•wwa° • ,w< - Ike A:Enter-Me Undotyino Coos.(Discos.Or friay That Wee '4S... .. > .,-TMEmt3RoetattgInDeada)Lnet C. �• • O% o.•Yla4an�.w,.«. v j,_= Pen a:Ftotlr other Sr T r�,=t3Caniginalec ate Otd' Rewire;in Ina Cane t>w��+Ctl p�j4MIM Pedumed7 ❑Yes NO E • C GQ YYY f° 1 Fa lma Avaaaria To confine Tno Caraa Of Oleg Cl Yea Cl No Z CHRONICARSTRUCTWE PULMONARY DISEASE C�` r ' ' - -- :r ,a, u C.�'- 31.-Mo Tn24203Uta Cemble.MT0Caat?7 12.-if e any a:• - • V't.,3 t a3.t.an.wt O;OasrA:O Q ❑mykar 4Yi•L5drn, ❑mrardA It.el wa a rn1/+s-.: 0.lroiu.4 ©Nailnla Hem.'ctda a Aoddo.M ❑Pcndmylrvesigtron 0 L ❑ Yo ® ProbaMYa Ne❑ Ilnknoail 0 n,rary.�r.eah.smo0Nila l rw ews.era+ • '.-��vvat Yam a Sd.cide❑ Cottd Naito Ostanr ai ' 35.tuna0!aitay 30.Flee to* •/5vK errs Hotmecncrseton Eaa,Netstauranl',Wonad Are.+) OT.Injury Al Work? z 34..OzbOrtry4xy(a!an7v'OsyrYaar) ``C.0 ❑Yaa a No f' - Sep. C to t. or .. 38a,Apt.No ,38d Ztp Coda • 30.lCG'a:on W tri,:ry-Sto:a Us.Coy OrTc \ lea G v = 3y.OesatocMeNWAY0c 0,4 f(Trantppc Ctio'ojury riff• r ❑C.•n�iOHtla i.+/,twrl� 1,/u!4e a Wuyoen t - - U . •mac 41. 1,2311n,.Ofelaon'bllWy40-ea,.seOfOanrc ' . �1 Cm[P0r(CtieahOfyOfrn� rr DAVID EBRUCE TRIBBLE,BY ELECTRONIC-SIGNATURE t:o i Coast(DMA os Comm W Health oKeor 43,NI:a.- d 1 Y0.7.1. PCola01 Parton 0anininp CW,a 010aa010 44,UaiMf/11111U 40,bate cr1511d DAVIC-BRUCE TRIBBLE ,5910-NOMESTEAD ROAD,FORT WAYNE,IN 48814 01039200A - 07/13/2016 !e.Abeitor(Kunorol Sweet Rnvi0er. • 47.+Ali: A • S.ti.I¢"ua at Local Heatsi Ostler 140.For naplelrar Only•Da4 Hod l�.ianWtlayrYenry m f DEBOGIAH A-MCMAHAN,VIA-ELECTRONIC-SIGNATURE b11 JUL 16 2018 . �^ - ., , _ AMENDMENT TO CERTIFICATE OFDUATH[ENTRY OR RIUINAL) Stara F,nn S]3ta' AT.ENTH2N ESTATE:"Ti i Social Osduslty a fa botnb rccua000d by No Male looney 41 otdar to p(n sue tetp0nsblUy.,DIsclaturo IS vORAta y and,lhd'S to abs no panalty for rotuttL • - -