Death Certificate - Dunning, Johm_7/29/2022 INDIANA STATE DEPARTMENT OF HEALTH `'
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CERTIFICATE OF DEATH 1 ,f
S a :/ Local No 001088 EDR No 000000780880 State No 027802 0 J)
1.Decedent's Legal Name(First.Middle,Last) la_ Maiden Name (If female) 2.Sec 3. Time Of Death
V
LEIHospice FacilityHorne❑Decedent's Horne 0 Nursing Home/Long-term Care Facility "d
0 Yes ®NO 0 Unknown 0 Inpatient 0 Emergency Department Outpatient 0 Dead on Arrival ❑Other(Specify)
11. Facility Name(If Not Institution,Give Street and Number)
LINDA E.WHITE HOSPICE HOUSE
12. City Or Town,State,And Zip Code 13.County Of Death 14. Marital Status Al Time Of Death Y'
0 Married 0 Married,But Separated ❑Divorced
EVANSVILLE, IN,47710 VANDERBURGH ®vefdo...ed 0 Never Married 0 Unknown
15. Surviving Spouse's Name 15a.Last Name Before First Marriage 18- Decedent's Usual Occupation 17. Kind Of Business/Industry 1
SET UP MAN MANUFACTURING 1
1e. Residence-State 18a. County 18b. City Or Town }j
4
INDIANA GIBSON PRINCETON 1
18c. Street And Number lad. Apt.No. 18e. Zip Code 18f. Inside City Limits? ,j
1016 SOUTH ADAMS STREET 47670 0 Yes 0 No s
19. Decedent's Education 20. Decedent Of Hispanic Origin 21. Decedent's Race
HIGH SCHOOL GRADUATE OR GED
COMPLETED NOT HISPANIC White
22.Parent's Name(First,Middle,Last) 23.Parent's Name(First,Middle,Last) 23a.Parent's Last Name Before First Marriage
RALPH DUNNING OPAL DUNNING HARVEY
24.Informant's Name 24a.Relationship To Decedent 24b.Mailing Address(Street And Number.City,State,Zip Code) _
ELIZABETH JOYCE VOGLER DAUGHTER 1305 KUNDEK STREET,JASPER, IN 47546 •
25.Place Of Disposition
25a.Method Of Disposition 25b.Place Of Disposition (Name Of Cemetery,Crematory,Other Place) 25c.Location-City,Town,And State
®Burial 0 Cremation 0 Donation 0 Entombment
❑Removal From State
❑Other(Specify): AUGUSTA CEMETERY AUGUSTA, IN
26.Was Coroner Contacted? 27. Name And Complete Address Of Funeral Facility 27a. Funeral Home License Number
❑Yes ®No DOYLE FUNERAL HOME,520 S MAIN ST, PRINCETON, IN 47670 FH10400010
27b. Signature Of Indiana Funeral Service Licensee: 27c. License Number(Of Licensee). 0
BARRETT W. DOYLE, BY ELECTRONIC SIGNATURE FD29500009
Cause Of Death (See Instructions And Examples) Approximate
28.Part I.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 Abbreviate.Enter Only One Cause On To Death
A Line. Add Additional Lines 11 Necessary.
Immediate Cause(Final Disease Or Condition Resulting In Death) A. ACUTE HYPDXIC RESPIRATORY FAILURE a
a..io!O,Aa A rn.aep.v,m Oct
Sequentially List Conditions, If Any.Leading To The Cause Listed On B. PNEUMONIA o .^",
Line A. Enter The Underlying Cause(Disease Or Injury That Initiated wmtor w.wcor,..4.ar.o.our
The Events Resulting In Death)Last C.
o.e to(Or As A censew.noe On.
D. Y
Part II.Enter Other Sitmificant Conditions Contributin,.to Death But Not Resulting In The Underlying Cause Given In Part I 29. Was An Autopsy Performed? \
LUNG CANCER WITH RECURRENCE IN LEFT LOWER LOBE BRONCHUS,CHRONIC OBSTRUCTIVE PULMONARY ❑Yes ®No k-
DISEASE 30. Were Autopsy Finding Available To Complete The Cause Of Death? ❑Yes ❑No
31. Did Tobacco Use Contribute To Death? 32. If Female: 1 ' 33. Manner Of Death:
0 Iwt Prep,va wa,ae Per Was 0 Pregnant At noe or ti, o an ®Natural❑Homicide 0 AccidentteAccident ❑Pending Investigation
El Yes ❑Probably 0 No 0 Unknown
❑enrteenmt ou,Repv op
a o lops fir,yea era.a r e ueam a 0 Suicide❑Could Not Be Determined )
34. Date Of Injury(Month/Day/Year) 35.Time Of Injury 36. Place Of Injury(E.G.,Decedent's Home,Construction Site,Restaurant,Wooded Area) 37. Injury At Work? 4
11,,1'11 ❑Yes ❑No
38. Location Of Injury-State 38a. City Or Town 38b. Street ,111rLr2 8 202`�f 38c. Apt.No. 38d, Zip Code ..
a
1
39. Describe How Injury Occurred �/'�<L -_ 1 It Transportation Injury, a�
JJJ///IMra.Z-KI/724/ �(o If Tranamr ❑vasse,ye. � n❑wurlsraotr,
GIBSON COUNTY AUDITOR -
41. Signature. Of Person Certifying Cause Of Death: 42. Certifier(Check Only One)
APRIL MICHELLE-SIMMONS TOELLE, BY ELECTRONIC SIGNATURE ®Certifying Physician ❑Coroner 0 Health Officer
43. Name,Address And Zip Code Of Person Certifying Cause Of Death 44. License Number 45. Date Certified
APRIL MICHELLE-SIMMONS TOELLE ,600 MARY ST., EVANSVILLE, IN 47747 02003410A 05/21/2020
48.Additional Funeral Service Provider .- 47. 'Akers:
48. Signature of Local Health Officer. y - 49. For Registrar Only -Date Filed(Month/Day/Year):
y
ROBERT KENNETH SPEAR:VIA ELECTRONIC SIGNATURE MAY 22 2020
- AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL)
() - [ 2 -0 7 - 2--o 3 - 0 01 1 6 1--- - o2
State Form 53395 ATTENTION ESTATE:The Social Security M is being requested by this state agency in order to pursue responsibility. Disclosure is voluntary and there will be no penalty for refusal.
WARNING. TTURNIS FROMORANG TO YELLOW WHEN RUBBED ORIGINALL DOCUMENT HATS ASHIDDE VO DPON FRONT THATEAPPEARSOWHENEPHOTOCOPIED ANA ON BACK THAT