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Death Certificate - Sprinkle, Joe R_1/4/2016 -- e.af:jr, - , ,. - --, - CERTIFICATE OF DEATH 1 ' INDIANA STATED .1 ' I II' iY :CERTIFICATEOF;DEATH.tRESUBMITz -:-4 ‹.. ..,.. -.:!;:. : : ..32.3 , . '1 -3',..,1'.'13 ";' .‘• '-'' if 1 I -r' ; " ; 7;3-: 33 -337,' ;T'377•-I11.> 733Ii, i7-3/r713;1,-- ;;% ' ' - I : ';311, ; ? "13'1 ' : N----• - -Irocal'No: ' ' .5 \ ---EDR No l. - - :. , 4-..<....- X.; 5.<State'No • •••,..,-<- S'. ••..... , ..„2.i. „ _J' 60018.2a L • . O666602iigie4.< ; ; ''' 052044' l '' . „,Decedents s Legal Name(FastMialle.last)7_::: :,. .----::::, :::,;),;(-: t.„,1&,:fola/enName(If female);...1., s.. ' 3:...vs: '2.!,...i : e...:.,.3.,Trne OfDaath„.: 4. Date Dear t:(14Fren/Day,*4„ , S JOER SPRINRCE`iit?. 1 r -Ns -, 3 tit !.:: .- "---, ..S. t.-- is`'.. ..,. ,: I ..ri- 'S MALE . '‘'`'*06:60 Am!! :-..? .--Aliootho15 ..---. ) i 252, 10:1I Death Occurred In A Hospital, -, ... ;' • f 2.. .10a. If DeattCtcurred Somewhere Other Than A Hospital t F.' '.: --I' ,% , ‘i ''"- " q . .., 6 Ye's 0 No 0 Unknown 0 Inpatiem 0 Emergency Depariment Cothetent 0 Dead on Arrival' 0(0i,;(sreamj , .,, ' ';,' • - 11. Facaty Name(If Not Insetnon.Give Street and Number) i . ' s • •. 2 820 SOUTH FIRST STREET t 12.City Ce Town Stan.And 2ip Cede. . 1 .. .._, PRINCETON, IN,47670: ti i ,i. ,132-County Of Death ." •; • ; • • 14.Marital St2WS At Time Of Death • (D Married FJ Married.Etirt Separated El Dammed ' ..,‘•• -- (' ,:•' • . GIBSON ':t•i:.„.-.:, 0 i'",.!*.mansi15,0 uni19 -•' ;•1 15. seaming Spouse's Name ' . 0 ,, 15a.-(If Vitte)Gne Maiden Last Name , - , 16.,Decedents Usual Occupdice ' % 17(Kind 0f BuSnessAnlystry„ , . r : ' -' • , • s r ', . '. . • , " . I. r ; il . - EMGE MEAT PACKING MEAT PACKING ' • , . . , it Residence-State • . . ' INDIANA i • . 1 GIBSON PRINCETON t. .... . .. • ..- , 18.c.Stem And Number " . „ , • . .• , . 820 SOUTH FIRST STREET „ - . - - 47670 Yes 0 ND • , - , ,t.. •19. Decedents Educaufe • : ' HIGH:SCHOOL GRADUATE OR GED , •,,.., , , ., COMPLETED NOT HISPANIC. • -. ; . !-S. White .i-" ' i. ; .- . 22.Father's Name(First Wide.Last) ' -' r , 2 7 .- , 23:Maners Name(Ant,Middle,Last) . , . _23a. Maiden Name- ,-- - . ' ` „ , • \ • • , . . ' APPI OSCAR SPRINKLE . : , IRMA RUTH SPRINKLE . . • IVY,: . ; . 24.litormanrs Name 24a.Relationship To Decadent ,..•.1, 246.Maine Address'(Street And/tenter,City.Stale Zip Code) ' ' ' . . . SHEILA SPRINKLE - WIFE • i• it .-- 820 SOUTH FIRST STREET; PRINCETON, IN 47670 ' i • 25a.Method Of Disposraon 255 Place Of Disifusinan•(Name Of Cemetery.Crematory,Other e) 25c.1-001.2011•City.Teem,And State ID 13:dal 0 ccernawn 0 Donation 13 Entombment R -- ' _. . ,( r 1 ; . . . . o emoval From State . . , 0 Other(SpeaY):• . EVANSVILLE CREMATORY. .., ' '',.. .-i' EVANSVILLE, IN . - ,, . . i 26.Was Coroner Contested?, • -• 27a.,Funeral Home License Number. - • ' • ' , . Dyes `1E1 No . , - , , • ' . , STODGHILL FUNERAL HOME.INC•500 E PARK ST,HVVY 168,FORT BRANCH, IN 47648 , t FH10900013 I 27o, Serena Of Indiana antral Service Licensee: • • ' 2 , - ,2" 1 .: , i •s ,2.- ; 1 (. : ( ' -. - ((•• 27c License Number(Of Licensee): ' - t I ANDREA LYNN:VINCENT, BY ELECTRONIC SIGNATURE i . "t,..-it'• .: i. - .: ••. :......: i.3.3 FD21400005 t.• ; -... .. ' J. - T. ,if i' 1 I 4 ..•-"Cause Of Death.(See Instructions And Examples)' !..,z.,..• ,, ' ApproxiMate .,..,./ 1 28.Perri.Enter TN;Chain Of F vent6 'Diseases,injuries.Or Ccinplic:ifinn;'-.That Caused The D'ath,Do Not Ertel:fir:initial Events ,- . ' • Interval:.Onset... Such As Cardac Arrests Respiratory Ainest,Or Ventrionar Fibrillation Wthotrt ShOwing The Etiology.Do Not Abbreviate.Enter OrtyOna Cause On• • 'To Death . • A Lthe. Add Addainal Linei If Necessary. ( •'.( ''..- ', •(_.' ...: METASTASES tnrhediate Cause(Final Disease Or Pondition Resitting In Death) A COLON CANCER WITH M I (-'. . . 7 YEARS • . . I . , • ( -,.i r •ci ti ea 4.•c..........e.On- . • .2 • , .; - • , • • r • Sequerdalty List Condaioni, If Arty.Unclip To The Cause Listed On a ' - ' '' ' - as , . I, Lbe A. Enter The Undertying Cause(Disease Or tritry That Initiated, , ,, , i.. s . : - .„ . . -The Events Resuting In Death)Last: , I - : •Z • ' - ' . ' . - . 1-e , ; , r * I. ; z ' : z i . , _ . . I Pal II.Enter Othar 53mtPeaLCOL6110.(aC Tel Nat ReNJItm;In The Ifnereornicause Gm^In Pan' • 29.Was AP Att(PP''Y PecIarnecr? ' . .0 Ya •tEl'in ,% I. 21. ...'''. C „ .. Ei-yis:El ith.,. '...4 31. Did Tobacco Use Cmitrzette To Death? " 32. If Female: 0 f:w 6;ann Yr.'s.nu 0 e'eraekter•ORW.: 0 Not eii:nieaute‘si:aii'ar.nat,.cira;a, : 0 Natural B.HalliCide 0 Accidera 0 Piping Invesodation '. :„,/ 0 Vets 0 PrbbablY El iiio,0 utikro:tin - : i - 0 Nitimni-t.its*F.T.7.1.43 her.Te!Yes'eh..o.as 'iatIrErcon in:rodinn n....v., f • 0 Stickle 13 Could Not Be Dethrmineo , : I 5- .(• 3, i .. 34.Date Of Injury(McidnOrrylYear) -. 35. line Of Injury - • - .- 36..Place 01 Unary(E G. Decedent's Horne,Canstruacn Sae,ReT'dttalt,Wooded Area)", • 37. spry At woo? •.. ,... .'t ' ^ • .. . , - •. • .. 38. Locaton Of Iriury•Stara ,: . , . ' • ' . ` • ., 2,I: ' l• . : . , ' • ' • • :k . . . . . . . : . .. . - ,.. 39•Desidbe Hen Injury Occurred ,• . . , Qice.resPre . P ' • • ,• ( 41.Signature;Of Perscn Certlying Cause Of Death: • 2 2. I, MAQBOOLAHMED, BY ELECTRONIC SIGNATURE-, .. ., :< < '‘, ••, , .... r.: - -. • 0 Carstang Priisician . 0 Coroner . .,-.0 HestrIoftse: ..°-"-. ,t •• 43. Name,Address And Zip Code ersce Certifying Cause Of Death ' ' ' , . i 2, . • r . : ,, ,' „ , ' , ' . ' r"'d? :: f •' • MAQBOOLAHMED ,421 CHESTNUT ST, EVANSVILLE,1N 4713.. ' • , : l . . ' 0105 4 3 4.3N -.. •,•' ‘. 11 1/11 0:1 5 j t 2 .. „ . . , . . . BRUCEBRINK JR;VIA ELECTRONIC SIGNATURE ' ''',',-. -. t .I. ':'.. i } i . t .. ", I:NOV16 2015 ''. ': I .r.".I i ; -'i "; 3 j '; ; r; :. s ; ; -; t ; i ; ;AMENDMENT TO CERTIFICATEOF.DEATH(ENTFty OR ORIGINAL): z '.!, •!: ! z 3. ; : ' Z ! , ;II : 2 F -, :4 .0:ith21.20iic ,I: `"`'• ''' „I f ),"; '1"•"" ; ik-Biradiei:sno 33---- 3 : h'" ..3- 1, r 35 37 :, ; I3T . t5-Fint swa,i,si, -- ..:, "--,. . : :e ... ;•• --:-.:"‘• S• - .....: 1....49 "1.1finc"I(.('`'"2, 'I' Ii %2 -3.'3 3.-- '3' - ,T '-'`ti 33f1 '3-'3: 't ' tz-Last:SPRINKLE ,2; '. .- .'i v.. <2. , -.... (.. ... .Z'( 1 t.: ` t t:-::` • .-1. 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