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Death Certificate - Bailey, Danny_10/8/2020 From:Princeton Creek Association 8123855226 10/08/2020 13:47 #043 P.002/002i -..Y•-r+,--- im r' RI ND NA':-�A;T E:�fl.. E A RT aE A TH� CE IF�t-�, R CA.• T tJF�. � EAT ENTIO lip`' TT N ESTA TE>`The Social Secur' 'M i - rN s'being`ieijueatetl ti'tFl)sstate; "i:. • �• ettcy n oftler lo,puraurespnsbil' Disejo` : i .'fun end(tiara vriu r ' . ..;:: ;: :. Local No000�75. ,, „.. �:. sire 9� ,tary lee tb' many fw� � 1rDecorlenraL al,NLoc `:EDR:NO',000000,807 •State NO kr' (. Mtddle.tasq, 807. :.> >.:_ x 0ath 4 Dat ,1p;c•Maideh Name 01-rnmale), 22 Sex ,3.Tme 4f Deem' :, Date' Death Df e>Y f , (Mo(m+ID .Y eery D`ANNY ,.•RAY B�� A F' AIL spew MALE Sewn `05:y 4'.ar N 6a` `-��Y` . flr+`. U der 1 YearO �; '.,. , •: .. Sc.8C.'Under.)Mordh•Bd.-Urider,7 Da', t.;ee"Under:)-H,?.,. �•'�': � 0 '?.` ``,.. - -,r,,,\, Y;: our'`..•'1?eta of Blrfh(MardtUDay.%•..' • 9.Birthplace.(Cry arid.Sfeta or Feraityt.Gountry), T' C ,:f, r ;.• I] H� a'f'T! �P Deceite'� �(e9 ❑ b� rtl'a Home`:.No Un ❑' �'' ;'knavirl, Inpatient:❑'Erneipe '�pe tOu fl� \. ,mDKomelL`` `IfemtCenFadli ., pcT pa(tmen, tp�tieril. ;Dead'on �,.., ; i, • • • .'`;.' •� '. '' 1604 SOUTH 350 EAST } �, .,12:'C+h',orTown,state.andTipcod. .. . '' „`•.•`': ,., ,. . . .. � ,.. .. .. ,. "' \'' _ • ':`', ;',' :l�.,tNsritel5t�usAlTime,DlDeadl, PRI • nieF.c.64 Haines eui 104:.1 l7 NCETON,'IN,47670 �P tnvacee', ;15,`SurvivugSpousebNnme, i r� GfBSON`-. .. '❑;Ndriw�ee ,,❑�'NaperMemad:❑.tinknowp; , \k`` ,`• ;15a,•`(If NAfe)Glve Maiden Fast Name ':,\1 '18.?Decedenrs,Usual, `ation , `17 .'' ,;\.:•.'°; - Oca>A ,;KktdOft3usineWlndustry' �� • HEAVY;EQUIP ENT.'TERA BAILEY , ,. M .19.Re>rdance,state LOGIaE':, .•'_"': OPERATOR HIGHWAY '? , IGHWAY`DEPT`nee.,County :,1ab.cfry of town. INOI AN •tr� .iec.:saea ., ., FtRINCETON'‘ „,_. ,. . ,. . . .,��':�,: :ttuna tJumber, .� :. , 5,', .y, r,•, • - - 18SL Apt.No. •!tle.;27p Code vial. Inside u�:..,'� •••,,, .City,mitsl,,,; :� 604 SOUTH`350 EAST • o y ;o 19.Decedents Education''°>`1 . ';` , • • `\' 47670 es No 29,;DecedentOrHispanicOrl9M•;:�, .�„ -•21�:Decadenrs.R, 9TH=42TH G RADE;NO DIPLOMA NOT:‘HISPANIG, '"'. • 22:Fathers Name(First Middle,Last). WFeITEt M e ;, `•, ;';;: \ ".i ` 23.•Mattwrc Name(plr!,Midple,.taaq': v' ,,I,,, :,1, 23a.Mothers ptaidan Last Name. RUSSELL'BAILEY.` 4.1n imam' Name ^ IRIIAGARDBAILEY:�';;'�'':,�'::•`:��:;•''. .. .. VVAGNE, �;;`, '2 fo eN m • 24a,Reletionshl ToDecederd'`'. 'BVeptAn N •city. R \.5 P :24b.'MaipgAddrase d u i Slat „•„'``� �: rnher.C'ry. e.Zip Code). .. • TE RABAILEY . WIFE . , . ,, ,. •• 1604SOUTH350 EAST;PRINCETON IN 47670 "•` `+`' ;25a.Method OI ititrn .. ' ■ �apos .25b.Place Of Diaposilion;(Nang Di Cemetery:Crematory,Othar place '-25F.,Locatl,n L. ; `+).;: ?n=City,,Toxm;AndState :h;;8urie(C]`Cremefiont�l nonation�❑ Entombment „ �`- `` . _; '; ., • Remove)From State! • i`' "\ if' ,- onier.lSae�rty�:'.. •• FRAM C1SC0 CEMETERY •;�„ , . ':'�' �•' FRAN" •26.WasCoonerC«!tacled7; 27. NameA Com leteAdd '`"";.'.''.' CISCO,'JN - - ;\' (� P ressOfFuneralFaa?dY;",'::;\:•;;," _ •', ,� •, ,,, \'; ',(' • 'r 27a,Funeral Han.,.%. '' •Number,'• .Yes ;\`• Ne: ,,. - ;l„• C'OLVIN`FUNE RAL�HONfE`ING,`425'�N'IV�AIN'S '=P . ',' 27b•'Sr'ignature Of(ndana Funeral ServiceT., RINCE'fON,,IN;47.677c.,l ) FH83005671 ,. ■ Licensee; ., :':',,,�;�, , �. ' JAYANNA:WEAVER BY :t '�``•�`° _ - zD21800025 umber(O(Lcensee): EL'ECTRONIC`SIGNATURE ..- , .`,::' • ,,, �'��;�•`• � • �'•`�` \' � is Cauca Of Dasttt;.(See 10 Hone And Exa es r .'28.Pait 1.Enter Ttte ChainOf Everil • 8 -Diseases;injunes,OCornplirations-7(tatDirectly,CausadTheDeatli;pcNolfrrter errifinalEverits ` aoiimate, Suet(As Cardiac Arrest`Respiratory Arrest;Or Vontrircular fibrillation Without Showing The Etiolo Do,Not Abbe of•gy.. eJi e,EMer 0 Or)e cause On •lntarvel:: i4 title.:Add,Adddinal'Lin(as tt Necessary.;•`' •� ,�Y 9� Onset i ' z:tiA': 3,.. `.ToDeatEl ST EASEJlENOCARGINO:. Q' ..R GASTROINTESTINAL TRACT WITH METASTATIC.`,{minedimi?,Cetne,(Frml Disease Or Coulon Resulting In Death) `•A:;:,:DISEASE TOTFIE'LIVER :•�•.,is.. egU9rltraList Conddions lf' •L - ;''�, - .IN, �; BadR1Q,[O The'Cetlse(.fisted An ,, '. -line;A.Enter The Underlying C,arise(Diseese.Ori FTY ThatInitiated; r `')+bta}. )i7ite Events Resulting In Death Last. :: - . . , '•.. .,.aa.A A ,` ` . . ..• • ^ ,' .. ...\`. • .• �PaAll.EtMarOther 'pnifcentCondNens Contributing toDeth13ut No t Resudn In haUrd9r ylgCaus eGINn In Pen ,,` - •29.; nluvry,Ped omad7 .\r��:. . . .,, .30.•Wereuto sY •n pAvaflable ToC4rp ate a Cause Of Deem?. •Yes obacoo Use�Conl+ibute To Death? - %%t.` "\" r� ;: ,'. 'Hamer Ol,Daath'`„ ..) • • .C] '•i;q.p.4., nPeYYP.i',;p,e.A. Ali .ofo..ttr„ ,as ''it' •T• A,•,C)Yea,.❑,Probably`0.Np,❑ Unlmam ,:,;•:,,,,, p,\,, .• •,•, l.o/o..,\ ••• C .twef 'CouldNot e Acdrrried ••Perid3n o .. .. . .. .. ` �❑.kmp;;v:w:emA+vey ai ti:y:'ro fyiir.DMpei.';< U� �eiol;n ii� ,:,. glm!es69atl n�'•`-' ..�: 34.:'Dete Pi'ylkrry(MontWDeyiYear) ,`35..Tim?Oflnlury� :`•:r, ,.: ;38. • `Mr' .•' O "e❑ CoilitJ tgdAre etarmine.3 • . .., ,\, _� -in11uY.( ' „a;l;onstruction Frith,R•staurent.Vtboded Area). .�7„`Injury At 1Norfc9: "•k 3) ,. .. . ,\�\•, ,.,�:�'` 'C7 Yes c'O. o' 3e.. `Of(� -State,Locaaon -ury. n1 311a.' ,Or7 City. awn,. pt `-',36d.`Zi Code`. P r� 39,:DeaeribeHow:In(urS ccuurred. >;` ...... `• ;\� ••;:` - :a, :y,;:: =�`Tnnspp�t�'minjray 'y:;' . , . .. ,.. .-.. .1t.,. �► is O nee I]�r...rrr.n • a� !tea Pgfsan Certityl Cause Of Death •>." V, ~�. :�t'�'` '`Q`� - �i'k .t. ChedcOn One \' _ l''" -;_APRIL MICHELLE-SIMMONS TOELLE.`-BY;ELECTRO IC40 • ., . Ce,•i•• `;clan ;;U'' -. ' rest dzf N SIGN'TURE: - naPhY+ • 43.,Name;Atld An p,code Of Person Certifying Gauss Of Death:,; -: •• ,erxaner: , Heath Cef trfF . ),y `"';\;, - -1 \�:: -04.`7.loenae Number.;' :�5;Data C t1 O ,y. ti` ::APRIL.MICHELLE-SIMMONS. ' 01 N `fOELLE;;$00 MARY)ST.,•�1/AN8�� LL''E 'IN`�7,747:�,'' C�;•,�"'``'�•,�`-_`.: _�02003410A , :•1 / \\� 45.-Addltgnal Funeral Sarylce Frowder., -;\ • O O2/2020` ,y t,a � �4;•„\L: - `���,.`,. - ..=2', 47, -Akan' ..\ . f}Q.`Signature of Local Heath Officer.` '. -- ..`. �� ' - ,": ',`,\`•• - .'J," ='�."G� �=�� '49.`forRefllatrarOnly-Date Fled,{ManNDaY(Yaar}:' `�' BRUCE BRINK BY.ELE _CTRONIC'SIGfUATIJRE�.. :,. .....,.,,.��\:;. . ;�t': •r = ;;AMENDM,ENT.;TOCERTIFICA ,•F•DEAXN(E''I 1 y I .Farm`.10f1 1 R R NAL G !)a `�M�, U EN�T'G `A HAS �ULTI L CO ORE,M D- KR$ G OU'�D�ON' P� ARNI NG• 1 - S,UMEN`,\NyITE S HIDDEN VOID. N FRONT N ATAPP'APPEARS WHEN PHOTOCOPIED.' OPTED. '.-N HACK THAT: ,- TURNS FROM ORANGE TOYELL7]yY WHEN RUBBF�3.'ORI 1NAL"DOCUMENTI•lA. A HIDDEN'VOID:ON FRONT�THATAPPEARS'WHEN PH07000PIEDi �'' '•^ 'd'«:"' , c ��_.,..ATE;OF;INDIANA 2 /�"_v'���' �� '' � ;�`,.