Death Certificate - Satterfield, Bonnie_8/31/2022 V-V-�-'-3Y4 s` if I�v� 'ice",L�l 4 W7i ,..^ .. (0,
,fir:_,11-i. INDIANA STATE DEPARTMENT OF HEALTH r` 4 ),e
7.•r CERTIFICATE OF DEATH 0 �,
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"Y Local No 000047 EDR No 000011083684 state No 2021-017652
�Y1 1-Decadent.Lope Name(Fiat.4 o.Len /a.Madan Name(5 ferrate) 2 G45 3.Twee Of Death
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Princeton.Indiana n
Ur 8.Ever ks US Mired Forces? 10.n DeathOccurred tt A Hospeat: 1Qa If Deathoonared Samawd:ere Other Then A Hasped ,.
9, ❑ou..6a .afyy ®Deoede" Horne ❑fhastnp FNn tnnpea.n Care FerAty
! ( CI Yes ®No El Unknown 0 Irgntina❑EmapencY Departaeat tD 4W55l ❑Dead on Anhui ❑Oe e.(Sperdryl
a11-Fl Name Not low n,Give Street east Murree?638 E Water Street
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�j 12 CXy Or Town.sat.Me ap Code 1 !I 13.Cau+b of}Death 14.MarthaStatus❑Uartfo4 sn Sapara+ad ❑DWarAa M
(a�1L Prtnceton,Indiana,47670 Gibson ' ® ed ❑�Martial 0 Unknown
l A 15.SuvMnQ Spouse's Name 15e.Last Name Balers Feat beanbags 18. Decedents lha+d Oompa2mn 17.lard Of BtuLtatld�ty I)
Robert Satterfield Satterfield Homemaker Own Home 0.
I,l 113.Residence-Sure 18a Campy 12b.CAN Or Moen t]
IN Gibson Princeton
rf Seem See And Nub 18.1.Apt No. 18eUM-21p Cade 1 bade Gay Letts? 19,.
ri(i 638 E Water Street 47670 O Yea ❑No 0%
21.Decedents Race
( lA Decedents f�.acotat 20.Demean}of fYipatlip Own
1�r High School graduate or GED completed Not SpantshlitspareciLadrio White
Q 22_Parent*Name(First.U.meo.Lang 9-Parente Name(P85.Saddler,Last) 23e.Parents last hems Berate First t.Mrtlape 91/
,0 Elmer Ray Ward 'Ili',i Janeva Ward Koerner ip
1." 24.ttarrnard's Name 24e.Rermaaho To Decadent 24b.Ma2MQ Addrosal(S wn4 And Number,CtN,Stan.ZM Code) I. I,I
ui Robert Satterfield i. Husband 638 E Wd,sV set.Princeton,IN,47670 PI I1 o
Q 2S.Puce Of D-sp,aloes y
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cc 25o Method Of DoWdaon 293 Place Of D4,po'%teen(MOO of Cemetery,Crtmaatry,Other Waco) 25c.Location-City.Toro,And Suted
tit Bull❑Creation 0 Denson❑Crcomb.renc 1
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cc ❑Re?ro.'d Frorr' a Columbia White Church Cemetery Princeton.IN
O ❑otter( :
0 22 Was Coroner Concocted? 27.Name Ard Compete AAlteas CV Record Facility 27 4.11k, • .Uoerne Number: r
Colvin Funeral Home Inc 425 N Main St.Princeton.Indiana.47870CC ,A }f•
I Yes CI No �.:5 t ..
I- 27b.Blames Of idles Furless}Service Ucaaee: 27a f9aroer(1 Udl I D21:,t 4Y:. cis
-J ayanna Weaver Electronically Signed Gi/L7
tL � I. Ei�Znagua 9b-Diseases, Or Complications--That Dtorty Caused Not Terminal Events.4C Cause Of Dead(Sos Instructions And Eraceples) G/e`SO .O
interval:Onset
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Such As Cardiac Arrest.Respiratory Arrest.Or V F33dasllod Warned ST1oetng The Etiology.Do Not Abbreviate-Enter Only Ono Cause On Cr C_ To Death .._
CI A Lino. Add Addteonal tines If Necessary. i:t " _..i, Sudden Cardiac Event U4, � Minutes
0 rtm.odIate Cease(Ftnel Dao�a Or Co..M&,n Raartriry In De>a41) A. +�_ ..
: Owbta NAC.e..e�o e¢ �0O/
r�y`t Sequmtkaey List Condition, Ii Any,Loading To The Cameo Listed On e' TO�
(V- Une A. Enter The(lndertying Cause(Disease Or Injury That initiated • 1,.'._Ii as..b to.r..Aov..aro of
C The Events Reauttlg In Death)Last O. ,I 'it:!
gqi Oa b ld it•Ga4.4 ek
L • I = . :a:
a:v-run• r. Not tieatitlng t The Underlying
Came Given In Pat 1 29.Was An Autopsy Performed?
. � :-T•._... 0 Yes t>d No
Positive for COV ID 19 30.Were Autopsy Riding Amite**a To Co.prete The cane Of Death? 0 Yes 0 No
►1.� 9t-Did Yab acco oho Conaib.tco Yo Death? 32 IIVeneto: 33.wanner Of Death:
:9 El Yes In Probably El No pip Unknown} ❑.mw.aeewmo o..vr ❑wren..Arn o m. D.rsa .•c e ..wo ea re a al.¢oe.e .b ®Hawse'El ttr Hawse' D Accident ElPenang bnesegabon pQ.c.r..,r,rc ru r.eo.w a a ow To.p.m.owe. El.iaae.e4se wrae'le stews ❑Suicide❑Coulda rott
Ad N Be Do ed
V 34.Data Of Many(4Axrl Vay/Y*ar) 35.Tires Of tram, 3a-Piece Of bt.ry(ED..Doce me
denr*Home.CautSon SOW Reeteruant etpWooded Areal 37_ ay At Wort? '
El El
r38.Locate?Of lrtuty-Stare 38a.Coy Or Tows 'I 38b eng.: -Be a Nmtb tar 3 c-Apt-No. 38d.Zip Cad*
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''L( 39.Descrbe How&eery dawned n ,.I- - - 40.a Transportation s e•tory,Spod
l' .iP.l: E lowsecesew❑rw wwwe❑ressrwa❑o..pe•r a
R41.Signat/e.Of Perms CattNtrtp Curse OI Dessau 1 L",,,1 42 Careers(Check Only Qxl� I''"I!je'I_}•.
►l.( Bm►stt 4N. •: - 1 CI Certifying Physk#ar1-• t81 Gnat ❑Heath Ofsmr k
43.Name,Adriess A.Code Of Person Cendytng C ue Dasac _ _ 44.Lber.s Nunder 45.bate Cadtbd
Barrett W.Doyle 520 S Main Street,Princeton,IN 47670 _ - -Z --• 03/29/2021 '�\`
lei., 48.Actlabnsl Funeral SerAos Pommel - .47.•Also:- �t"�
48.Signore d Lead Haeat.Otec*r. 49. For Rechtro ores-Dot Pam tHeranitmin'� p4/01/2021 7 u
f,( 'Bruce enek5r Electronically Signed
t- A&LEADALENT TO CERTIFICATE OF DEATH(ENTRY ow:INN(N-40 W.
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>) ...Koren.5 ATTENTION ESTATE:The Social soeuray a to being rsgtma0ed by this state agency to order to WOO*.!e ry-Dledostra IS Yosadary and those wN be nb Pub Oar fYtwd... �C
(j' WARNING: ORIGINAL DOCUMENT HAS A MULTICOLORED BACKGROUND ON SPECIAL WHITE SECURITY PAPER AND THE GREAT SEAL OF THE STATE OF INDIANA QN BACK THAT
TURNS FROM ORANGE TO YFt IOW WHEN RUBBED.ORIGINAL_DOCUMENT HAS-A HIDDEN VOID ON FRONT THAT APPEARS WHEN PHOTOCOPIED. ��
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