Death Certificate _Armstrong �e4 INDIANA STATE DEPARTMENT OF HEALTH
t•, 10ERTIFICATE OF DEATH
ATTENTION ESTATE:The Social Security#is being requested by this state in order to pursue respor1s y. D isv�y art thane wni be no peaty`.r re rsa!1 )
Local No 000163 EDR No 00 000804560 State No 050582 �� rr
1.Decedent's Legal Name(First,M'rdtYe,Last) 1a Maiden Name(If female) 2 Sex 3.True Of Dea.•i 4. Wire Of Daft(Most••De>NYeaq
BARBARA ANN ARMSTRONG ;! BROWN FEMALE 12:00 AM 09/15/2020 5.Social Seemly Number fie.Alp-Yrs Ob.Urdenl Year 'tines Utter 1 Month 8d.Under 1 Day 8a Under 1 Hour 7.Date of Birth(MorOhrDay/Year) a Birthplace(Cdy and State or Foreign Country)
Iq
li .
Hospnd
•
f' 4 j,.'lit, ,d,Hoaploe Faalrty ® Decedents Home ❑ Fogey
Cl Yes ®mNd I •Urdmown ❑ Inpatient❑ Emergency Department Outpatient ❑ DeadonArti,rtli ❑ Other(Specify) Nursing "Cie
11.FeaTity Name'Of Not Insibrfbq Give Street end Number) ,; . i,
503 NORTH MAIN STREET } �Ir,,,, ',;0 r,!, '"
,t
12 City Or State,And Zip Code ''��,,,•,, ''1. 13.Canty Or D th,,, ', 14.Marta Stabs At Tune Or Death
PATOKA,IN,47666 ,ii;11;i y1'1 ;:a.,;1';ijjll,1l EllMarried Married,But Separated Cl ,
• 15.Surviving Spouses Name 4,r v ,
GIBSON, 'lI ❑ widowed ❑ Never Married ❑ Unta nn s
1i,11 •.., 6 ' 15a prwue Alf ' Malden Lao Name ••",:! 16 Decedents Usual Om+P 17.Wet Of Busenssflydnatry
HOWARD'ARMSTRONG I HOMEMAKER DOMESTIC ?18 s Resdmce-State
I.,1 Iln Ili,' 18a Catty p'I I l';k l j 1 18h City OrTown
I III) ll�la INDIANA GIBSON '`
18c,Street And Number . I PATOKA �,' '''
,I s:�" 18d. Na 1 y�rill 'l'lll�l'j 1�' MI'7iti,. !I'Y1 'il ee 27p Code 18L i side City.LBr�s? /
' 503 NORTH MAIN STREET'' 1, . '' 47666 ® Yes ❑ No
19:Decedent's Education I I I,
... t 'r'• 20.Decedent ffspanicOripn li' ,�_ 21. Deasdernt's Ram .: , ,•
HIGH SCHOOL GRADUATE OR GED '
;4 ','1'i u ,r'' 1
COMPLETED NOT HISPANIC1''r' ''" ''1'
22 Father's Warta(Firms Middle WHITE r 'e•,."i, 'i;!." %
��!.I r' 23.MOBner's Name(Feat.Middle.Lag) ,II 1"', '1. 23a Mother's Maiden Last Name ��
.10i,''.i,' .:, Ili:
BEECHER BURTON BROWN JR' ,;, �' la
KATHERINE VIRGINIA BROWN:5 RIGSBY ar ,1,, ;
24.IntonnanrsName •-' I ,•I;+°. 24andatiatshipToDecedent 24b.Matt*Ad&ess(Sheet And Nutter.My.State.ZIpCOO .'ll '
.:;,,:,1' yl IL:'` 7,11 1''
HOWARD ARMSTRONG'' , :, '1' HUSBAND 503 NORTH1MAIN STREET,PATOKA,IN 47666 '1ai;L„,"."' '
zsa Milne i Ot won 25b•Place Of 25.Plan«Dspdsg on'." ■
II
❑ Bain®1Csn"a4'at❑ panatian❑ 6M,r„A..at IfI(N ' '' mom.Crematory.Other Place) 25c.Loagon-Cdy,Tarn,AndStale ';I .11, L 1'
❑..Rerrnar rote State l ti l' I i' 1!
'°!i oo,ec'r(St E y): EVANSVILL CREMATORY EVANSVILLE,IN rl
29._Wet Coroner Contacted? 271„Name And Complete AddressOf,FuneralFaa3ty l,'1.j.' .,r�'ITI' 27a.Firmed HoneLicenceHunba:
• ,
El Yes ❑ No ;.,r 11y I,..' 0,1, 91:'1 I ., I1,1.1I;P
: ' COLVIN FUNERAL HOME INC,425 N MAIN ST.,PRINCETON,IN 47670 FH83005671 `• ■
27b.Signalise Of Indiare Furoral,Service'Licensee: .-
MARK R.WALTER IBY:ELECTRONIC SIGNATURE 27c. wnnber(OfLxernaeax
FDD1013013010 ,
10„"4 r "" Ca&$.OYDeath(Sea lnsf isctl s Ard y•es) I '''l ;) ,I
28 Pat I.Enter The Chain Of Events-Diseases.In LtIes Or Conp8catiore:That Directly Caused The Death I'. of.,rI,,,,, ertn �n , I Approximate
c Such As Cardiac Arrest,Respiratory Arrest.Or Venurionfa Fmstllation Vtfithout Showeng The Etiology.Do Not -,d TT Only.Y i - . Kntival Ore!
II A Line. Add Adddinal Litres If Necessary. - -'';^,;•I To Deatft
ii,
Immediate Cause(Final Disease Or Gandhian Resulting In Deaht)).. A. ACUTE MYOCARDIAL INFARCTION
4;--,'I I, ion a.A i' MINUTES te
'.1li •Jil la pF 1 )r•.r,
,If11�'l''n n f1 I H ' ; -
sequentially List Conri;time. if Arty.:Leading To The Cause Listed On B. HYPERTENSIVE CARDIAC DISFASt�V l'1!V.I' 19 21 I Z L' YEARS ".''.it
Li Line A Enter The Underlying Game,glissade Or Injury That Initiated sum to.A.A oo
The Events Resulting In Death)Las{':!L"i.' C.
Part II.iEitlat,OttnaSiorrr firant Co n t!+rts C �r_,r.to Deaer But Not Resuting In The Underlying Cause Chin In Paftj I Li O N ( {CAS lye ti,; '•;I ,j]
I': I;:I _ i;, ❑ Yes ® No
I;•F', '• ,1,)!'I.1•: 30.Were Autopsy Ftd'ng Avatar*To The Cause Of Death?
I r' I I" El Yee ❑ NO
91. Did Toba000 Use Cams xda To DeathT,•:t,,, 92 If Female: 19:t Mama Of Maas PCO
"'a;::''.'; ti'�' ❑ r t,tsaessa,P..tr.r ❑ eaa,.sies..asea. ❑ rrosnms.elavr.7s vomorous ® Natural Harris' ❑Aeodant CI Pwtdnglmaligaton
❑ Yes ❑ Prebabty❑ No CI ,,UNctorrt"; ❑ tw rurprsaar+r.rr.rnw..tton CI ux�eRramav�n.rwra ❑ 5udde❑ CouldNatBeDetermnW eJ
34.Date Of[Noy(Mori Day!?tj I,.;;.. 35.Time Of Katy 33.Place Of Ir uy(E.G..Decedent Home.Construction Ste.Restraint.Wooded Area) 37. At Work?
��4�
:_yt.'; li'i:in! fI ❑ Yes ❑ No
.; ,38:idwtiat011reuy-stale 38a:Cit• yOrTw'n ,._';;.I..,,: 38b.StreetCode `t
:. I" .1l ll.,,.; , 1. p. . 3� No. 38d.Zip r.
•ll`t�l',�''lli, •
• �.r`�
,,.s('I..: I"';I
39.Desaibe Hew!ritzy Orxured ...•
1:l, ""$::.I AL'''If T kyuy Y`(%
iilll ❑ e.� �❑oarl�i)
41.Slgnafrae.Of Person Certifying Case Of Deans' •
1 42 Cert 5er(Ctmdn Only One)
MISTY G.HOKE,BY ELECTRONIC SIGNATURE • . -T= Cl.ce,sryingPhysician ® Coroner CI Heath ORtcer 4
43.Nana.Address And Zip Code Of Person Citifying Cause Or Deatk r.II _ :iQ
i` • 44.License Number45 Date Certified
MISTY G IHOKE ,203 S.PRINCE ST PRINCETON IN 47670 09/17/2020
48 Additional Funeral Service Provider. SIII.(I 1, .r _ - 47.•AID
i ICI:'':1'..,,II!:' - r
'48.Signabae cf Lod Health Otiar: :Ili:;''' .11
- s 4a Far RegLstrar Only-Date Filed(LtontlOyMazY ki
BRUCE BRINK JR,BY ELECTRONIC SIGNATURE -- �, ., ;L . _ SEP 17 2020
� - i ::
CDl1- D4- ale -�30a - too. L ct D
State Form 10110(R813-07) •. .
WARNING. ORIGINAL DOCUMENT HAS A MULT1COLOP.ED BACKGROUND ON SPECIAL WHITE SECURITY PAPER AND THE GREAT SEAL Or 11lE S,=,=C. :;,, C'i -;�s=r; '
• TURNS FROM ORANGE TO YELLOW WHEN RUBBED.ORIGINAL DOCUMENT HAS A HIDDEN VOID ON FRONT THAT APPEARS WHEN PF.;;?a,-T,M
(✓,.• v v v
., .si,�:/B �`:/` ../, ,ti y • ► ! ► A ��J7:1l t ;and c Cl t -,ti.:-
- lVIA