Death Certificate - Dewig, Charles W_3/13/2019 vrrz*-,rex---.c-•tea.,7 •sr smtmrrs arc-c Fsisi�$' ' 'li7 a u „F'r
•41;k - 4 / INDIANA STATES - TMENT'.OF-HEAL
1 . CERTIFICATEOF DEATH L
.rti'-,t J.•"LocaLNo 000225 "t. - EDR No 0000005461'21 ` state No 057335 .. E.
Oece..nt's leg&Na e( euj4 a Las,) tA..Magm NS't"(It female) 2 Sex 3 hne Of Dears a Date Of Dens l'MaY4Da)
r
.- - .; - -
CHARLES W DEWIG MALE 1.20AM 12/0212016
Swal>I.rur-f encat& ea.-.;Age Yrs I Ea Uno 1 Yea 1 6c Und A oust(er t 60.Under n t Day 6e.Oxley 1 Hour 1. Date of Bnc,"(Me t VDayfear) & -•B7Vlace(City esd Sate or oregnCouy)t
TtanAMnpdal,- -
• ":.`." ;.I, 0 Hospice Faciiry ®Decedents Home '0 Nurses Mm retong-tern Care Faetty.
❑Ye ®No O.Uncnorm 0 Iron rn❑Emegeny Depatrner40.:atin 0 Den m Final 0 Ci.w(�^".M Y I 'N. i -
IaYy Name,Of Not L,s-.ttc t Give Szeet and Mayer)` - . < .
2 WEST RED BANK ROAD - •
12 Cry Or Tox:t Sat.A:xi Zp Code - 13.Gouty Of Dean 14. Maras Stairs At T.Of Dee:,.
Elmaniea 0 Maned,BLt sapareted ❑Drixtac
FORT BRANCH:.IN,�S7648 - - - GIBSON O Widowed (a Never Mimi*a„O Un',o.rq -
, 1 _Sssvoug y'•_rse's Name - t5 n a last Name Before Fen Manage IS. Decedfs Usual Oc tstcn 17 ,etc a 9rsnerstrr5ntry
•
ISANARALEA DEWG ` LODecedentscBUTCHER ' I MEAT PACKING
S.-Residers-Sbm..:' 19a Co'ary . 1.3e, Coy Or Town r • I '
INDIANA - GIBSON , . FORT BRANCH _
sac Steal FrC Ns'.oer - 18d. Apt No. 15e.•Lp Cole 1St.Inside Citytim:s?
2 WEST RED BANK ROAD - ®Yesp no
, 47648-
19. De:atents Edw..i. ! :20. Deceder_Of Hispanic Oriaus 21.Deadens Rate - . ,
HIGH SCHOOL GRADUATE OR GED • .-
COMPLETED - NOT HISPANIC . . White 1 . -
22.Parirs Name(Fest.Mi6.::e.Lan) - 23.Paresrs Name(First.Middle"last) 23a.Parenrs last Nave Be'se Fes:Marrow
WILLIAM'E DEWIG . - HELEN M DEWIG TIEPE
I24.1.'vbmarKs Name,- ` 24a.Relationship To DecedentMaim24o.Maf Adorn wri s (Street And Nber,City:Sate.Lp Code) ' <
TAMARA LEA"DEWIG' ,I WIFE 219 NORTH MAIN STREET; HAUBSTADT, IN 47639 -
25.Plane Of Dispostam
25a.Method Of Oisposron_ " ' 25b.Place Of Disposition (Name Of Cemetery.Cremato
ry.Other Race) 25c-?nmoy t -C .Town.And State
❑anal,EI.CrenaJm.0 Donator0 Entomt ant _ '
❑Removal Frei Stare .
❑One:ISpea»: ._ '..- EVANSVILLE CREMATORY EVANSVILLE,IN " - . . " ' • '
25.Was Coroner Contacted? - 27. Name Art Complete Address Of Funeral Fatdy- , . - •. 27a.Fuca Hone License Number.
p Ye: ®NO WADE FUNERAL HOME INC" 119 S.VINE STREET, HAUBSTADT, IN 47639 FH83002990 "
27b.Sigraaae Of 4bdana Fseeral Service licensee: ,. + . - 27c.License menber(Of Licensee):: , ' '
' ALAN:J.WADE,,'BYELECTRONIC SIGNATURE - . . . . FD01017080. •. - . 2; "
_ Cause Of Death (See Instructions And Examples) _, • rgpproxin
. r,I ate
25 Pa E.er Th ''Cna Or Even s'-0 ceases,I„Ruries Or Complications:That Dirctly e C eaaused The D h.Do Not Enter Termial Events•. IrceSeal-0nset-
' Suds As Cardiac Arrest.Respiratory Arrest;Or Ventricular F6xilalion Kunst Snowi g The Etiology.Do Not Abbreviate.Enter Only One Cause On To Death
t. Add A Lil Atldtioral LFr If s Necessary. _ .
(immediate Cause(Fetal D seisea Oi Cond'.ion Restt:ing In Death) A CONGESTIVE HEART FAILURE - • ' '
Sequentially List GoisE:tions If Any,Lead,ng To The Cause Lis eo On B' .. Ow u IS...Cwwww pV
Line A Enter The Uidedyvg Cause(Disease Or Irytay That initiated'' •
The Events Recut 160,ln Dean)Last - C, ..
- LW bIP u.LwvmM
Pan IL Enter Otter Siorv5ca t Cruet:ions rnntbt ric to Deem BIa Nol Reuling In The Underlyi g Cause Gneen N Pm I 29.was An Autopsy Performed? O Yes '®No ••••
t 1 r 30..Were Autopsy Foxing AvalsMa To Complex The Cause Of Dee.:` •' ONo'
31. Dix Todam Use CAr tb1s To Death? - 32. If Female: 33.-Marvur Of De>d; ,
❑Yes ❑ProzbN®N ❑ll 4npn-n ❑ a rw pa ear 0P.owune olD.n Owp ec a e ern.ra o...ao..o ®Neural❑Homdae ❑AccidW ❑Pmddgl estgawn
' _ . O eta vied ore v.rbeaay.sei.ve.b.cY? .O.vs vns+w wets rho he tr. O Suae❑Cola Not Be oetemurta •,-
34. Date Of Inyry(.MmUYD /7Year)': ' 35 Time Of injury • 36. Place Of ConstructionR Inca?(E.G..Decedent's Hoe,Construction Sae. esawmt YboaM Area)`. 52-Inj ry AI Kb c? ',
l •
_ • ., ❑Yes �0 No
35. Lou"ionO Iryvy-Stan ,38a. CityOr Town 38b, Store:V.Numoer 39c Ape tto.. 30d Zip Code
I
. < - " J .
35:Dew•Ce Hoe IryuY CRlmOd - 40. II Trenspotation Irytay,Specify;', '
I4',. St sauce Of Person Card yi g Cause Of Dean 42. Cert5e'ICE et O.vy One)-
ANTHONY T.INZERELLO,''BY ELECTRONIC.SIGNATURE . ' . - ®Cerrryrng put skun.. . 0 C«men -p netto:.car -
e3. Name;Address And Zip Coo Of Person Cerayrg CauseOf Dea:R • 44, License Nmeer 45. Date Cer ed
ANTHONY TINZERELLO , 1033 MOUNT PLEASANT ROAD, EVANSVILLE, IN 47725 . . 01052964A--• . - 12/06/2016
�4o-Fib zonal Fsaterm5erxs Pioed .. . • �s"
rb. Sig-ore al[ual 49. For 3lrar �I Di ear)),
, BRUCE BRINK JR VIA-.ELECTRONIC SIGNATURE ' - , .. . . - - ;. ..e 116
1 AMENOA.ENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) L
MAR 1 3 64. oao ova oo
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