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Death Certificate - Isaacs, Charles_11/6/2020 THIS(S AN:OFFICIAL COPY.OF RECORD OF DEATH.ORIGINAL COPY ON FILE AT THIS COUNTY'S HEALTH DEPARTMENT Warrick County Health Dept. Boonville,IN 47601 INDIANA STATE DEPARTMENT OF HEALTH -:r , .1 CERTIFICATE OF DEATH Issued APR 1 Q 2008 '''±' .. Local No State No ,.L. a egal Name(First,Middle.Last) Ia.Maiden Last Name Of Female) 2.Sex 3. Time of Death 4.Date of Death(MonlhiDayNear) Charles Taylor Isaacs • N/A • Male 01:45 PM April 2, 2008 5.50c ecurity Number 6a.Age-Yrs 6b. Under 1 Year ' 6c.Under 1 Month 6d. Under 1 Day 6e.Under 1 Hour 7.Date of Birth(MonthlDaypYear) 8. Birthplace(City And Stale Or Foreign Country) 85 Months • Days _ Hours Minutes Lebanon, KY 5. Ever In U.S.Armed Forces? G 10.II Death Occurred In A Hospital: 10a.If Death Occurred mewhere Other Than A Hospital: ®Yes ❑No Unknown 0.. l3 Inpat ent 0 Emergency Department Outpatient CI Dead On Arrival ❑Hospice Facility 0 Decedent's Home ❑Nursing Ho nelLong•Term Care Facility ❑Other(Specify) 11.Faci,4y Name(If Not Institution. ive Street Arid Number) Deaconess Gateway Hospital 12 City Or Town.State,and Zip Code 13.County 01 Death 14.Marital Status Al Time 01 Death P9 Married 0 Married.But Separated 0 Divorced Newburgh IN 47630- Warrick ['Widowed ❑Never Married ['Unknown t5 Surviving Spouse's Name 15a.(If Wile)Give Maiden Last Name 16. Decedent's Usual Occupation 17. Kind Of Business/Industry Mildred "Isaacs Ohning Shipping Agent Shipping )8. Residence-Stale ' 18a. County , 18b. City Or Town Indiana Vanderburgh ' • Evansville 18c.Street And Number led. Apt.No. 18e. Zip Code 181. [aside L ity Limits? 0 yes 6 No 14100 Warner St. 47725- 19. Decedent's Education 20.Decedent Of Hispanic Origin 21.Decedent's Race 12 years No • White '22.Father's Name(First.Middle,Last) 23. Mothers Name(First.Middle,Last) 1Ja. Mothers Maiden Last Name Claude Isaacs Emily Isaacs Clark 14.Informants Name 14a. Heiationsmp to Uecedent 14b. Mailing Address(Street And Number.Lily,Stale,Lip Wide) Mildred Isaacs Wife 14100 Warner St. Evansville, IN 47725- 25. Place Of Disposition 25a.Method Of Disposition 25b. Place Of Disposition(Name 01 Cemetery,Crematory,Other Place) 25e. Location-City.Town.Arid Stale P9 Burial❑Cremation❑Donation❑Entombment Ap r i l 5- 2008 ❑Removal from State ❑DE.•er(Specify): Locust Hill Cemetery Evansville, Indiana 26.Was Coroner Contacted? 27. Name d Complete Address 01 Funeral Facility 27a. Funeral Home License Number: Ziemer North Chapel ❑v,, ©"° 6300 North First Ave. Evansville IN 47710- - FH83001910 lib Signature 01 Indiana Funeral Service Licensee: 27c. License Number(Of Lice -" FD01010309*( 'f' Cause Of Death(See Instructions And Examples)23. Part I. Enter The(Thain Of Fvent4-Diseases.Injuries,Or Complications-That Directly'Caused The Death, Do Not Enter Terminal Events Appr.• ate Such As Cardiac Arrest,Respiratory Arrest.Or Ventricular Flbflllatton Without Showing The Etiology. Do Not Abbreviate. Enter Only One Cause On ':\e% Int- S: Onset A Line. Add Additional Lines If Necessary. /9 '/ /J��J . T�e-ath Immediate Cause(Final Disease Or Condition Resulting In Death) A. [, U ,.k.t��C�� h`e�� "" /DC �' ,. �� Due rota A.A tanseauee°e an Sequentially List Conditions.II Any,Leading To The Cause Listed On B. 1'/y/4 /Ca/e.`"` c? .1 ) _ A. As Line A. Enter The Underfyina Cause(Disease Or Injury That Initiated ' Dwr°rOeAeACeneeWereetill' S ,Q...,7e a/ .,/V 2;-,-e The Events Resulting In Death)Last C. Due b To lBr AeA Consequence Orr V. D. r � - e or 1$ es-( ee/5. Part II. Enter Other Significant Conditions Contributing To Death But Not Resulting in The Underlying Cause Given In Part I 26. Was An Autopsy Nertormed y oyes N`o_G,o JU. Were Autopsy Ymdings Available I o Lompiete ` UI Ueath!❑Yes ' Ifi No 31.Did Tobacco Use Contribute To Death? 32. If Female: 33.Manner 01 Death. 0 Yes C Preha'Jty O No 0 Unkrowri 0 Not Pregnant Within Pail Year O Pregnant Al Tan.a Death 0 Not PROWLBul Pregnant Wain 42 Days Of Death p Natural 0 Ho icide O Accident 0 Perdng imesbgetion O Net Regnant But Prepare 43 Dap To Tel Year Berme Death O Unknown I1 Pregnant Wthtn The Pest Year p Suicide O Cold Not Be Detemened 34.Date OI Injury(MonthrDaylYear) 35. Time Of Injury 36. Place Of Injury(E.G..Decedent's Home.Construction Site,Restaurant,Wooded Area) '! 337. Injury At Work ❑Yes ❑No .A.Lncu'ipn Of Injury-Stare 38a. City Or Town 38b.Street 8 Number 38c. Apt.No. 8d. up Lode • OES ' 40. If Transportation Injury.Specify: 39.Describe How Injury Occurred /� ��ff /\ / -) 2 - 07 ^I ` Z ' 'I I ,1� /` ❑Dmer/Opereim 1]Passenger ❑Pewesiran❑Other lspeohl 41 Signature. • f1//') I `/ `il 0 v {I 42. Certifier(Check Only One) -0 2_, it;Certifying Physician 0 Coroner 0 Health Officer 44. License Number 45.Date Cerabed t .game,A dr s A d Zi Code pf P rson Certifying Cause Of Death: urt o t�e�, M.�. 0/0.'6 9s-6' c� //v =f/ c'g 4011 Gateway BLVD, Newburgh, IN 47630 47. 'Akas: 45.Additional Funeral Service Provider: ,j -4E Signature of Local Health Officer . �J_ ' Y /; 49.her Heeletrer Unly-Uaie Filed IMontrilUayivearl: _ _APR 1_0 2008 :- -.. .__.n..n,e,ran,,.,-r ceae,FSr ne:TM Sinra,ISheitropuv.iiriewas,.gsM.yE ebe aPans sin!Uby ira'.e-�,wai cegi4n_ _n 9191M11ffyi1MII1+Itt2)1 Et1.'�0Milit�i ill;F:RIS1AV9:iii4l1l� '. '.