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Death Certificate - Freudenberg, Jack L_1/9/2014
L-0-514.14eTIV/TCC*57-111:.Cc'cirabalA:31 • • • ' ?al.1g5he.i.n5Cr--5,1.15-.11E2,5.fliEtral.415-55.5-5ER--21..V.E.- rt.DEZI.;.ILMTW5-51; :''' -1.1" ,e''. 7- \•-•-'1.....-i;:::.71-11.'''''';:;:c..2-%.;.;/:-.11:';':;Wititil, I ':' C;.t.--7---:-.11-.--- " s' '''--I;-....."--:-:-----;;;;Z---2,r..--'-:..."-:" -.."1..-7'''':::::, ..-::;;*:. :-Z...- e :'..-..:7• .-..;,.--:‘-‘5.4...si",-;;;I:liriu.„:„..-i:Iii....4i.c....11,its.---;.05,4,..-...;:•,:),:-.---.-. . -----•,t--...--1.--1,---„•.,_.; ..,!! . , „fr,...L..,,„!-..;.-7-1,4;:,,,i, RE„:„...,31 ;p,,iii,m-s....11„..„.....11i,,, .:, .1.'1.-.L .;: 4(.1: il';-:1-',4-;'/..fri,>51(fW%-rti= 4-.,-=:12.i."?;-= ''.-•...-.---P-NSi'-E',-W.--ft -W:inlIi0.7-4;;Irg..--;1"------/ ':.;.-f,---;,,,?-..e.':';',3:-:-..Iiii'A'.;‘514k.zz.-.':•--, --4),-'e jP.,,,,t .1 ! __?iir::::5111:.(1116Chliblal, .., .„,t1; ' --cePePart, 54-..e9a ..;.. _CFILsyrIlh.1-.e,19.7.;',,',--'2' 51;2" '',..-.5?.co•r.ri"y`1":946I'Vh1.3 Nafr,h141'err) '.,!1 .5..t.C.r.r.,-;>:>a,;•2.-Se3;,.!",,:•,•;.i. ,.3.;Woe Of.Deap:2-,,,,..: '4. Dale Otpeath.Okrainzleat,.7...41• jir: te?;4:t_i‘e 17-■ -ji,c):4,. t:,: 2'H . ,ea ' 1 t.,..:::;1111freyielL L a 1..'ill,I,L•ztr,..Liihntitc:^Alip :!illTref;,..*4:;,:-; 14:.„t•LL5t,";:!'i 1';:r LI k[1:elitliCe .iPe e::iii. -..1• JACK CFREUDENBERGtsktre-"' S .:' ..s.s, -.== f::.----.:..Eg.'-i ,-,c--S-fliP.. g:c-.'1..:N."--4":TV.,..i5"41c1.4.1-.4.-??;MALE ;s"‘08:45 PM...:.-1*) .1:s.c:SsC7)*;;.12/I6i2-01:3'..*:;512 .-.ts":-.;* .„ ;- 80 , . Motto . ‘„-; DaYs, -, 'j-li-....---5-:-,,ArS tqP.4".35.55-...1.<5 ..1-..,Y.s*,>....02/11/1933S: . ;BARTON TOWNSHIP IN L 9 Ever in U S.Armed Forces7., 10 If Death Oaarrect NA Hosprtal: -, ''' : --551,,i ...._#5,1 1 1,10a.lIftleath°coned Someyaere Other Than A Hospital; 3, ;.: .t.), i' ''-'5'... -..' ' '; "" '''.55''' ..,...''''' ... '.'''..." ''',5:-:r55aS",55"-,,,; ,a!193Pcs citcf1,1Y.i:)ReSernI19,71 la Nurr9 Nofh.,..elioR9-101Care a,d1F)',`" '',S".5.Z.:. '''",<T•',"." .z, 0 Test:0Na-:0 U n k n o w n 0 Iratient 0,Emenlancy Deparrnent Ou"Slatie-ol 0 Dead on'Arrwai :0--attiiiiiii,C5..54a=•1; --.. ; ‘ hr' L. At,'" 5,... .; .< ,," ' iasFeatly Name;(If Not Ins5titon Give Street end Number)i ) t: r it .Tcnvn: tate. d z - •' - .-..‘.i c;r r-•-•L,•I.,-r5 t;-.-.t.E,•S•:,t,-y s D PINEHAVEN HEALTH AND REHABILITATION CENTER : ? )2cy osAnip ce .: s s,. nOfDeath trt:C3...4.-- t:C' -: :; t 1•.':- :E._ -i .:'--'.' :- "; -.•:;E ..:.s; t E .- , ' • ., 14..Mantal Status At Time Of Death- I .i. ...‘• ''..-."' 7 r" '”...„/ ‘, . AL,: . ;?...... t-5:fr.'"k2f O.'......-•-`1-5-1''' ,:i 0;arm/clip M.;thed;BUiSedaniltad aDivdicad st EVANSVILLEz.IN;s47720= s-ss:.;" j .....s. •.„ \ -„,s':' =72.401.".-.75st=ii>lt:,-..:= .• VANDERBURGH2 . !;=, :< 's....;= P visiticYs.9,ss 0 Nt!,!.friimed :0...UniCen;: i15.,Susy.Misg Spouse'sRame i .c....o .,.....,..o., i o - ,:' . 15a...groWer4eataaclien Las:Name 1 Or ::....) ..t.. ..; ,181•DercedentsysuelOceopraon ; i 17,,Kirr 01BusinessAndustry ,.,..... \h, 't '''.• '' :-.) , ..; '.: -.s":77."1''; -1- "1'5•• '....c"...";" ';;.5,"; L'', A -;•; ; . ...,., ;5 ,I SUE FREUDENBERG ... ' .. 'L = S , MASSEY i•-*,•-• • .:Sf.=.Ps: =:-... ; . ,:s.." . FARMER' I s s: - ' AGRICULTURAL- ; sst INDIANA s;=.1:.,.', *:.):...;( Ls',12s'scs, , GIBSON l.'s*: 1..:::!.sr... S*.ts.:"Ls„, FORTsBRANCH:22:::, ;Css:-.,-,,, S .c..•..= ...., :11,...s„ E:7:', .<",_ '","C't7CC:. • , , C.• ,a% :- t... i. - ••E C ' i 1 C '' •.,..: : • ., , , ; ;. , .. . . t ' i . C.1 'Vt..: .'2, '7';' . ' .1. '. tt '.. t. '. t E t :3 .' ''' 1. • ''': t. ! 7517 EA...T=775 SuUTH ' =. = ' Z. = - . ...• = 'Dyes 1:E]No L . : 'c ;: ' ; ',"...1.•C -...*:1.-; -2.1,....;.,‘' S ' :. 47.048 .s. Ls I 19.Decedents Educe-599 d•; ss.. s. .c s c 20 Deoedent Of Hispanic ongn o; i,.. ...,--- ;5.■ o I...a/Decedents R.ace; ;; • •- 1 `t .• L •. . : , .. . HIGH SCHOOL GRADUATE OR GED " . *s.„ .1 :-C 't L- .." s*-- I ..,../** *-",ss vs t' • S• • s s,,,s s., ===. • s s . s s .* 1 i iS; is ‘ ' i., 11 c .-: !. .. ::'. : 'i...-::- "- t ',..9. 1 - --; .- --;,..,;;•,--.-", :-.i.;. :-,:i. .,,.: -.::::vi. i.., , . AL ,-, ..,, • LEONARD FREUDENBERG s s s .' 1 % ;; I % is .:*: HAZEL FREUDENBERG s - - - . . 1 HENDRICKSON s s= ; ! ' • J: ' 24.Informants Name ..• r : • L „ ' s, , ?aa.Relauonship To Deader:1; ; ;;;„ '2"."tingscci:13!(Street„APd Nrcter.Qty.stye.z,p.cede) c •s• is c • re e .. t . v„,...... ' SUE MASSEYst:S. s•• s•-,t-• . .. ••. * s SPOUSE< S.st ; ....sis-Scs'S 7517;EAStss775 SOUTH, FORT BRANCH, IN 47648. :S:' s ;•.-s. --'1,- = 25a.Method Of Onposnin , s r ; . L 258 Place Of Disposition(Name Of Cemetery.Crematory.Other Place); •25c.Lccattert Qty.Town.And State ;L o r ; . • . . ita esu•sses Ocremation 0 oci-nabec 0 Entomomeni • - 1 ; " ) .• i , " 1 ; ' I ' . 0.01-sessispecityy '',.* : . s :' PROVIDENCECEMETERY, .s.. ....fr . -s.. .s.c FRANCISCO. IN c ../ ' .- -... .. ... , ,-... 2 .26 Was Coroner Contacted? .•--, 27. Name And Complete Address 01 knee!Family-... ,../.•-..--„ .t.;, ,ttr o. -,:tv•-., ,---, . • , ,•• -.; 27a,Ftneral Rana License...Noddy.- - t ,L t : " STODGHILL FUNERAL HOME INC;500 E PARK ST HWY 168, FORT BRANCH, IN 47648 % FH10900013: c 0278 Signathre Of Indiana Funeral Sena Ldernee: 7 ' • C. " C , 7 ; • -.:-.; C.'; a ; ;ES • • •. ; :27c'License Number(OfLicensee): :. , ' ; .. ROBERT S STODGHILL; BY ELECTRONIC SIGNATURE ; ..=. =sc,.: sk.; I st.,-; Ss •.c t;:• .•• .s= FD01024378 = •. *.* i ' •.. ,s ,• .-S= -, ,, s= - e •., '.L. t - Cause Of Death (See Instructions Auld Examples);,..o' 1. t `•. "- interval Onset '- 26 Part L Enter The'Chain Of Events:-Diseases,injuiies,Or Complications-That Orreztly eausi-cl Trie De'ath..Do Not Ent er.,Temtinal Events"t, ....• .' Such As Cardiac Arrest,Respiratory Meat.Or Verarioular Fibrillation Wthout Shovdng The Etiolog,t.po Not Abbreviate.Enter Only One Cause On - . . . Al.Line. Add Additinal Lines q Necessary. • ; ' L • . ) ," ) o ".Q ;5. L . ,- •,o. :-.1 h .; •'•7 5, 5 , ;•-.• " ' ' ; ' • s I ;L r. ; Irdmediate Cause(Finai Disease Or Condition Res.-ding in Death)' A. : END STAGE ALZHEIMERS DEMENTIA 5•! . ; ; • "s. i - -- 1 , ;" r • ' ; - ) tI O. ..1- : i -- I cx. 5•771"°°°:. 1 - I ' • ; • „SequeiRially List Conclitions;;II Any.Leading Td The Chase Listed On" B..'AczNEHMIRSCIISEASE - . 0,..,-,. a... .: . YEARS 'Line K.'Ehter The Undedyini;Cause(Disease Or Injtiy That Instiated• "" 7- ;' );" --/#• • t -• ''t -"1 --' :: c•• ' ' ' '. ' 1.- ' .//. " •, Tile Events Nesy(ting In Death)Les, ,-"'•,.'L ; ' ' , • C. "•,.S.. ,•; .,;•::'''- :', i L ,, ..'s„.''' 't. , ...' , , '. r f; (' -'' * ' : l'''''-- '`.. , L. . ., - . ,. ,) 5 ,,O.....nots,theiye.e....00 • ' ; % • - s ) ; ; . • ' ' „ ; a: : i. :: _ Z ; ! :: >. 1 ...-, . i ..: ; . . . ipan II.En*,Other • teat • •tons • • n•10 Death But Na Rest4tng In The,Underiying.cause Giyin In Part I • 29. Was An Acton Performed? ' " - "" ..• r ; - -•''" ,..- 1 ' .-- -. '•-• ••• • ,' -t " CORONARY ARTERYDISEASE HYPERTENSION CHRONIC RENAL INStiFRICIEneY,OSTEOARTHRITIS ‘--- i 2-Iv ..-. -,. - .-' , r. . ;.• c .- `, 0 Yest0 No .; s.. :t C. s ' I , , : '-• " ..0 ttei}nd;:n vinare..v.. 0.F.-yijensi is.apt; 1'5...i.!..p. ., 50...,,,k.c4. 0 Habitat Li Fi?ftscide 0 Aho;Ven 0 Peni-nithiyehhgaPip ;.0 re! p F;Pb.abiT■:,1'4°,0.. -1^,^?"r , ;0 ' ,,,, „e,,,,,e,,,hT,;; ;;;;";: ..--.0 udi,..'f.,e One:es va,...;;;;44.a.t ;t El stickle 0 co.n la Be Deterrntried i 34. Data Of Injury(i/tontlYDayrYear) ;5 ; •' 35. Tens Of Injury '. t -• ' 77.36.t Place°finery(Ea:Decedents Horne;Conn-union Site:Restaurant Wooded Area) L •37..kitty At Won? '5,.„; , ! 38:locexel aInjury-State . , • r < 1' i • 3 : ; : • u ; ': t • :- , .., .,. - • > i ' ! '39 Describe How l.reuty°owned ) .: -• . .•. - . . - , - WILLIAM E. SUTTON , BY:ELECTRONIC SIGNATURE: :-..:ss :4 .i."-,, tt- .. ....'..• ...',4:-:-/'.' ,.. O'Cert-fying Priisidan •-,'-0 Eon:ner L -- 0 HeatiOnter j: 5 ' \• ) 43.-,Name.Address nd Zip Code Of Pelee CenlyIng Cause Of Death:•' f • L ;Lt. ,.' i 1 (f. 5 .1 "o • WILLIAM ;SUTTON ,813 EAST 4TH. STREET, SUITE ANOUNT.VERNON:IN47620--;- „I i'.- . t-: 01030020A st .s= ss `, .12/19/2013: L. $ I i 4B;Dinette?.et Loca HeeiSt Officr i- ,,, ■,, ,.: ,t-„ ...,i 1.:f:.:.1% , , <9 Foc Regisrar Dnly.,Date fied(MothDay/yea, ,.... c f- --•,.; RAYMOND W. NICHOLSON:JR.,WIA ELECTRONIC ....., • SIGNATURE. iiiiiairirttsisi.ii:.-;;;=.:::14(7.., 1 .*:,Ss.'s: .1.ss; I. ==s DEC 23 2013Ss I. , c .2, 7_ It L. ; V t ; ' L L c :.: - AMENDMENT-TO CERTIFICATE 0E.DEATI4(ENTRY.OR ORIGINAL);, : L C. C. 7 ;,, c !, 'CZ C -... 'i• 1-j.: ' -1..•';.; I ':: '.,LL.,., 2 i :,....„:" Li- ', "-4 ? t;LL ? -/ ,,:?..I I.;5.1' .(4';?';i, t .•,.. E.-! :.,----',..4%; tt :2 -/4'!;itt.'& 1::-.?: Wbr-cs.41t1 ta.4 E:4;'1 i., 14C-1.ffic's,..--t14,; ;;;; / .--.....1;'.:-. 1 :: LC `;' ''-...-R '.k1: ::.?-ft .t 34-....% 44; ;:- .; :r; -t :' .2' I -....-;;;;>::::>.:... 't3.kt`A*btt'tt_trt`t..-S:' r•••-::::';'4.1.-,-• c'Z'S-4‘ ;;;L:44=...; -; k= . ;--.'t- 4,'+..4'7 4-:5.-'',5•:.■.; 5,%z• -sts, "'State Forn15359E;I ATTENTION Esp,w.9*Social Sedeiht a is being rat_is7ie'iiftttltiilStiteCiietitirifSkleric92;iiti iretifs....lobtill 9isat9Ni2s"lotaltataildqiekrixotige;rio:pitaititcii rtfucv.1";1:1;_iiii fte•k,41 4; :4)Ji4 '4114■2"'a "4 r?,:iiiicitiAC.Sticirithr(Aii Xe.4ift,fCouisgo iAcredFitiatiNeoh sP Oak iSrreikukrv.PIPF:FiAND.TTIE dathcr siAi.421'4 simi.okiciA ON EiAdii THA__„._f 4.:`. - WARN N G::. Fiv ttnombaetnic4 tr TO-.-LLOW WHEN RUBBED.'ORGINAlimmiumegf HAs HIDDEN V•DON FRONT THAT APPEARS WREN P140TOCOPIE6_,Z,SP5T-•"..•R'5',57r.---TiZhS __,