Loading...
HomeMy WebLinkAbout- Lepeau, Betty_4/6/2026 W Jr�,ls66.SkraTV,el.00,11sibuu-, .i•e9s>J.Vs.ra...a .err-rm.., -.�u.•rr __.__ _ J_- ,,�, - - _�. �I.�il �� �Ip7,I Itll'�,�I'"� �� , 0,,. .. `:Iv'`''tr.r• icii DEPARTMENT OF HEAL.T. 1 f {� >r 1: ._ CERTIFICATE OF DEATH Atiqii..A -- 0 ‘1 illy Local No 002403 �; ,, EDR No.la9I�0119.71695 State No 202111101129 1129 k 1.Decedent's Legal Name(Frst.Midde,Last) „it 1e.Malden Lest Name(Tf FemEN) 2. Gencer 3. Time of Death 4. Date of Death(Moran/Day/Year) I . 41111LS••• •• . Betty Lucille Lepeau ! I�• Sharp Female 12:5. 3 AM 11/14/2025 5. Social Security.Number 6a. Yrs ';;' i t) •I ear Sc Under 1 Month Bd Under 1 Day6e. Under 1 Hour y, Age- ;, �',,�wllbi�te �,rth(MonlhlDsy/Year) 8. airthplsce(CNy and Sa`e a Foreign Country) 315-30��1�OIII `'"l'I 95 ""`"III °iy' "°"" thiltir 'tom 04/10/1930 Somervillei',li`'dial Ilidial I' 9. n . ",firmed Forces? 10.If Death Occurred n a Hospital' • ff Death Occurred Somewhere Other Than a Hospital: i II ,. n n� I ' N .'• ip�ioe Fadlily ❑Decedent's Home ❑Nursing Homellong•Terrr Care,FaOtiIl �,'IIII',Ilu'll, ❑l'e '. l No Unknown❑ ❑ (npwent ❑Erergon� Department Outpatient ❑ e :..' . . 'QC (S eci y) t;}. Facility Name(If Not institution,Give SUeatartd, r ni l jinn ill ,�l'I'' it I I.1 .6, ill. Linda E. White Hospice Ho �rh h II "Ililiii! '�q , ", 'lint ,, ;nail is llllll, It• ll ll , 12. City or Town.Stale,and 21P Code 'I': 'I'I ,'yr � 1- ...:'' 13. 'beat' 14. Marta/Status a!Time of Deatn ` l� III i,;,I111i11 I•II III,'.Ii�I' Evansville, Indiana, 477 p Varteerburgh ❑ µarm! O Married,but S-• " ` • • - , 1114141,141 I Il ul � ® it(a Never Married 0 Unk r BuMving Spouse's Name 15s, (U - 6, '- - tattler* 16. Decedent's Usual Occupation "' :elnd of Businsas/lndastry • II, Homemaker "1• • I• Own Home • l • • 'B. Resdence-State ea. Countyifillielt,. 18b. City or Tewn T1TI: ill' lot, . U. IN Gibson Oakland City u' P 18d. No. Be. ZIP Coca 18f, IrgJ city Lirvts? 18c. Street and NumberWw Apt. I 930 Williams S re, L 47660 DYes ❑No i % 19. Decedent's Education 20. • • ' ' 1 • Origin 21. Decedent's Race 'D:I�) i:'I4i jiii High School graduate or GED completed No' r^'I'A('•• l �•aniaJlabno white Iil'Il! 'Illk�ll IDr 22. Fathers Name(First,Middle.Last) • 23. Mother's Name(First,Middle,Last} l,, :!'i 23e. Mother's Maiden Last Name ,'1 49 , • rlllBlljh;li49 Eugene Sharp Avis Sha illli 11I�. hill.. Jenkins 24. Informant's Name ' t' 24a. Relationship to Decedent 24b. Male*' 1((Street and Number.City State.ZIP Code) ! "''' 'ilijq. hill Sarah Lepeau ' liiillikki • Daughter 930 Williams Street, Oakland City, IN, 47660 H!4g11,ul 25. Place of Disposition 'I r 25a. Method of Dirposflan 25b. Piece of Disposition ll(f�prMA�,Cemetery.Crematory.Other Place) 25c. Location-City,Town,and Stabs M M -®Burial ,❑Cremation 0 Donation❑Entombment . DRemoval from State C ry 'l. Somerville, IN �� ❑other(Specify): Somerville� �t�rlete 26. Was Coroner Contacted? ' f. . Nams and Complete Adl#ess F I+erai Facility i 27a. Funeral Home Uoerlse(lumber ®Yes 0 No \ ,,,111i';)Is . ,6rn-Colvin Funeral Home, I .I II'' FB422000131i''B' 'I�'ii'li'1 •Jiii, '1i;l;L ' nc. 323 N. Main St. Po Box 278, Oakland City, Indi . 4, •'• " 27c. License Number(of Licensee) I III "" '" 27b. Signature d Ind ana F ,,5„e�f��Licsnsse "' 11 Iji, ;, Jayanna afar � liilj l• I`I II I'I Electronically Signed FD21800025;Hii." ii. II ,lid'' ''' ;iil1ltli,ca e'Of Death (See Instructions and Examples) ;;�II,''uli„i�I,i;1,, '' II '"' II Approximate 2$. Part I. Enter the Chain of Eve►)t�--diseases, injuries, or cot. t�Of)s-that directly caused the death. Do NOT enter Terminal Events such a� jll I ,I cardiac arrest,respiratory arrest, or ventricular fibrillation wiihobjlt,oiii�hg the etiology. Do NOT abbreviate. Enter ONLY one Cause on a line.,:A dill'I' Interval: Onset additional lines if necessary. I ii I i;' I To Dea.tip A. Complications Of Femur FleigLt�' Days _ Immediate Cause(Final Disease arl!Qp�ldjlib�l'Resulting in Death) 1' . Totoresacar«rurwork i Sequentially list conditions. if arty, leading to the cause listed on line A. Fall at Rehabilitation Facili •..' B. ,14y's'i' Enter the Underlying Cause(disease or injury that Initialed the events II ., il" nu.1 o(Or ea a Conasgrncs orb 44ell s resultJ'gp,death;last. c , - Due To(Or as a Con w ssgnce Ol) t f„i r ,I 4 4141141- 1 i 1' •;nlNi, PVT II. Enter other, nif)canf Conditions Contrff ,tins to Dealt'Dud Not reu,ll,rngl,n the(Jnderlyvrg Cause poven in Part 1 29. was an Autopsy Pert d es ® No I' i1 I IIII III 30. Waro Autopsy Findings A �`t, omelets tho Cause of Death? ' 1 ,II jnl ,II i ''II' ❑ Yes 0 No ,jinn 31. Did Tobacco Use Contrlbcte to Death'III' lbl' 32 rf Female: l l I'"r,llI,1 33. Manner of Death ;t'III.�'I�i:i III' a III. ❑Yes C]Probably 9 No OUrtk'10vm' 0 Nd Precut Wtrirn Past Year 0 ortgnart at line a Death ❑Not Pra and,WeVari WI71ii 42 Days ci Dead' 0 Natural O Homicide 0 Acodent C]Pending Ines • ,'.4t 0 Nd Prevent but Pregnant 43 Days to 1 lee Byre Death f Unknown t PterartWMHn the Past Year p Suicide O Could Not Be Determined 34. Data of Injury(Month/Day/Year) 15. Tkne of Injury a6. Place 41 ii)tlry,(E.G.,Decedent's Home,Construction Site,Restauran WRoded Area) 311,.I f i at WoIt? �,, 4 ' '' it ll I I• • '�ll!'il. I..,'. �. 1i10/2025 Unknown Good Samaritan Home & Rehab „I'• '. i 1 [5 Yes ®No iiltll 3. Location of Injury-Stale 38a. Cty or Town 38b. Street and Nurr.tier , I I" "' Mc. Apt.No. 36d. ZIP Code �' ,I ' ' d ,IIl II 1II! li 11111• II I III I i;. Indiana . _ Oaklan 0yr ' 231 N Jackson Street r' 47660 ? 39. Describe How the Injury Occurtody ! ,;yllb�lliljlgl l Il�lil 40. If Transportation Injury,Seedy 44011: deciiki was In rehab at Good Samaritan Ranab and had a unwitness4.d fall ❑o^"'"Oi"sic,0 Ptsw, er 0Pe°euran 0 CAN~(sgersy) I'' • 42. Certifier(Check Only 41. SlgMlura,d Person Certityrng Ceusd of Death One) l - I" -•, kl!:1, D Certifying Physician el Coro{1er❑ Health Officer 44. °1 t 'll - �- .Electr ibicall Signed Brya�t;�e� `iJnderwood Y 9 ❑P►lysician's Assistant ❑Advarc.d Practice Registered Nurse l; I I! 43.Name,Address and ZIP Coded Person Certifying Cause of Death: • I 44. LlceSae Nurtbe, 45. Date Certified i;,l,Bryan Lee Underwood 201 South Morton Ave., Erattsville, IN 47713 -,;,h iIlr, II,;,I, 11/19/2025 46. Additional Funeral S r e Provider '1 "II ���' - llil. 1t, I; 4 • 4d. $bent re of Local Hee ' 1 pill:. llll'u "iI't r( III 49. For Registrar Only-Dale Filed(MontNDaytYear) r'I 'I.11"'fill l' o+tic ''Ili" 'lllb Electronicall S( rid 11/20/2025 tow x„Spur jr is ,iilil,. .. Y "I'It' i'Ili411u'1Ii AMENDMENT TO CERTIFICATE OF DEATH(ENTRY ON O,UOINAL) '41„mini 0" f iilr,;;!l`iiill'' tii'pil! ;I .. - _ lCGil .; ,.i �� l 1 ;. C) � CO J� . 6- (-44\u---.. fit � ll ' I I ilrllr. he' a' _ •w'...t3),I A I i-s)ATTtSt1Oh t••.•t T!.son•...••••s•.n•.e•.n•e M A•rr�-s•s,. -essr.�s.rw.r•.•e•...a...............a tK e,tco M nee Sams Aw co,s,o•sn.•►ee,c,a.a J.,t•III '.I)1 II•,. 1,'all II I I" .'',IIIIi.'III; .,IIII'il,. // C. C ililft„ ,..;Illjlj ,,II}I )ljl. �'.✓ '�111'11.�Ill,l�llI ti�1l,tlllll ',,,��rM ..I,J�' lat. e••it E, e a w e n _ ORIGINIAL:ID©CUMENT HAS A MULTICOLORED BACKGROUND ON SPECIAL W1}I ` . ,CURITY PAPER AND THE GREAT SEAL OF THE STATE OF INDIANA.24 iAT