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Death Certificate - Kramer, Stuart_1/9/2020
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RTNI Nto Fiti EMIT H c:::-;-': ,,-... jii i'''''::.;j; iire:::: i 1 rc;::'..:z 11 i;.";c:--..,,:1 i''.•, --''''-"-:'-':: -..,. ., ,.,.,.,..,,,... •:-:,-,,,.., :-.-, 1:•=,.,. •; z..-_,:, •,. ..........,.... -,..,_,.,,_,,•,....-. ,. ..,..:..,,,,.. . ,i .-,.; • ,i,,-- •--...-•,..c.,..--::•,-,,... !•,-<-N ,v‹,, R•t, ;.„...:,-,if.0,74,...:. 1-,\-s-•::-...:,._ ---.,,,,--:::,,,•::-;•.,:,-.---::,',..-,••••:-;• •.- •••••.-......yi:,:- .-::•;•-,-.----I'zs.-spERTI,Ei CATE-OF DEATH=.•z-:-,,:',.:: .:::: .,-;.--.- , -- -,:: :: : : :,,.;•:-,--,---.1--. ;.: ,`-:,7,:f.,•:,..-:. i ry,-_il'-'I ---• j)1/--:- : .":;,,,: 5.:‘' '' '' :11'• -• ..;:i '-''''''i'-:::;.i I rr:::.;;:311 ''''';'-' W>_:;:!•11 • -.,•':'!: ''.;'-..; .',' ..%,'!: ,..••;:i ,1.) ....._.;,-:.)-'•:.:.,„,•-Z! ;•.:,4., '!..,.': ,-,' • "- "-,/' -f,'.-ll;./../L;:i'%,•!:::‘. ; -• ,•: ':,..i; _.::•,'4 .•, , d..cf,„I/ '.•;;-`-..ii, 1;,---.:,,. ' 11',;,".:3. J,l.%:"--i •.: , •r-.--r.,,;)i . ,, 1 -'..-. •"-,-, 'l ll-.....•• ' l'-:•.fl ;',,;.::•:, •,. „...,-...,;,-, l•NeN,..4,,Ine n, '..i.1.11--V'''-- Co4i.3rie;.'14)002....3.T .:_=1,._;, -..:\,:': '-‘alt).k-.r'sli;:'-'00000051„52-2,1-..... ,- ..,-..• ,...--state6.-uz.-.1,-o-..4. •6\,•.'-‘,..&-,...---..r,-,.,,,' r; . „:„..,:Decedents Legalli•rame(Fj(StlMiddla,ASt) ; '.•'.,,,. '.•:, 1;;,,, ." '",):>;';' : ;;•;),a; Ma5err,Naine;(1f,fernaferi Its,..".':::',',•:',,,;: •2;Spx:; ":„7.,%.i 3".'llme,OPeath,,•,,,;;;:•-.4. Dae..Of Death(Montli(Dayffe,ar):.- 4';',. ' ,-,"•'-' ., -'' ' ' ',• ' --""...0!`l" '''- ' , •: , ' % Si'' '-''''-j,'.1%..-.-i,TV•,-21.1'," •:k, l' ,----i'r-:-: , -.•'; :% , . ..,. 0 .'' ,OPIA, ; -,, .?-f5 -,!, f, /%1i ''i , •' ''''''''$-. -I '":-:..'-,-''\'' ''' `'`.,‘ . .- P ' :' ...0, . ,- ,,, '.•-•• ;' ,I1(',-.-;;•-. :`::-.-:. .:: '..-.. ,,.; . - ,,.; ,..\, .. ..-..-..,-. ..,, ,..,,,.... ;_/,),.‹,,..:::-. •:_ :::::,- 5, Social Security Number 6a.Age-Yrs 6b. Under 1•Yeyr .6c. Under 1,Month 16d. Underl,1 Day 66'...Under 1.'Hou'r 7: Date of Birth (Month/Day/Year)" 8.-1;iirttiplacp(Cirty and State or Foreign Cauritry)', Y.. . s ' > „•1 O.If Death,Occurred In,A Hospital: : ..,-;,/l ,,,,,,,:.; ,., ,,,,,,,%.: 1,0a. [(Death:Occurred Somewhere Other Than A Hospital r. '-',,-,",,,;, -: %.4:..:" '''',,- .•;--''', r /" .r„ • r ,: ' ,- . ;:.s.'• .,-•. ,••"•., '. s•••.;:. ..•••••sl"‘ .,, •O Hospice Facility d'Decedentsl-ame, 0 NuirSing.Hor.mkong.terrn Care Facility .•••••:•,..., ,..,...,• ••'.:ss• is 0 Yes a No..0 Unknown 1:El Inpatient 0 Emergency Department Outpatient,El Dead on Arrival" ,th bti.i.er( "•-•e:.f.,;). / 1' „,, ''''.•, ; •,-, ;i,,;,'''• .- ''. • „•. . , ...ii: Facility Name'(If Not Institution,Give Street and Number), •5 l', •"•• '••- ` •. - "., -, • • if • ' / -. -- . • ":.• : '• ' '. •; :-C. •; .. .. - --:: DEACONESS GATEWAY - f' • ' - ''• ' '`. .% :'.. :'-',, . . ,12eCity Or Town,State',And Zip Code ,, , . ..' , • • • 13,,,County Of Death . ., , / , 14.-Marital Status At Time Of Death • '., . . • • ,,„.,:‘ . . . Married 0 Married,But Separated 0 Divorced•„„ . , .,Ei Widowed 0 Ne•:•er Marrie'd-,.0 UnkOwn '`17"' NEWBURGI4, IN,47630 , . ' ,/•-- '••• s-"WARRICK ' . , , •• , 15. Surviving Spouse's Name . .• 15a.Last Name Before First Marriage :'„ .: 0',, 16. Decedent's Usual Occupation '• .' ,17. Kind Of Susinesstindustry' • •J, . . . , . • . , • ,, • N„,.. a PATRICIA,KRAMER . . So1:1 NElbER -; , ... .=• ', MECHANIC, • . , • , LAWN AND GARDEN ' 18.'Residence-State .:' .„• •,, ,., • ,. 18a..County .,„ /? . ".. /' ,:. ,18b.,City Or ToWn '•...•' , '. ,/ /11., ( INDIANA•- '' • , ' ... GIBSON Ik :, • P.;.,,` rORT BRANCH ' '- •' • . , . '-, „' „ ,•„: 18c.%Strept A"nd Number ' . 5,.,' ,,, •".., - 18d.'Apt.No.". ; -18e.Zip Code:" 181. Inside City Limits? ^ , ' . , . ' I - '• ,,1 -', •.. • , ' -, . ' ' N •• ..,, 596 NORTH MAIN STREET ,, . . , ,-- ::, ; ,.• 0 Yes 0 No ;. . ' , ,• ' .., .‘47648 . ,,19. Decedent's Education' / ":' • 20. Decedent Of Hispanic Origin i.. ., --•,. ' 21. Decedent'aRace - ASSOCIATE DEGREE(AA',AS) ! NOT HISPANIC '''..,• : •••,,.•.= %.•- White "- - ' / 22:Parent's Name(First,Middle,Last) : ', . , "-,,, : , / '• 23,Parent's Name(First,Middle,Last) ,. ' .; 23a.parent's Last Name Before First Marriage - ' - - - . , ,',..l. , % ,- .:‘... ...-' ,' •:' , : • . BERNARD KRAMER .. . , ' . „' - -, SMITH• / ,..; f DOROTHY KRAMER t • 24.Informant's Name' ..., ,.. ' ' 24a.Relationship To Decedent ",•' 24b.Nailing Address'-(Street And Number,City,State,ZIR,Code) '. : , . :" ' •-..-' '• --.,: , ,,' a „ •: - ,,,,, , .,,,,,, ' .' . \'‘-..•-":., : ,•-, .: '. ' 648'--'• ••:' - ;,•,"" • : PATRICIA•KRAMER '-.. . SPOUSE ,. :' ''= ,•' ' '' ,506 NORTH MAIN STREET, FORT BRANCH Ift47 .. „ . P. , . , . ' ..•' '''••• :- = =.3.... 25.-PlacOf DispOsitiOn ". / , '. : . ''''• ''. •''',-- -' ',- .. .., 25a.Method Of DispositiOn, 25b.Place Of Disposition,(Name Of Cpmetery,Dem-eta:1y,Othet•:PlaCe) ,;25c.Location City Town And State, g . 0 Eiund Z Cremation 0.Donation U Entombment •: : . •• ' • '- -", l;'' .'" :" , •,.. . . • 0 Removal From State . , , a „ 0 Other(Specify):•‘ • ... ; .• - HOLY CROSS CEMETERY ..=:• •'' '. , '-•,,,l' FORT-BINCH;,IN -; • '- .26.Was Coroner contacted?. l 27. Name And Complete Address Of Funeral Facility •%"' ",, -:." l• . -,;•Y ',.;• .,-,‘ '''. „ ; . ,: • " 27a. Funeral Home License Number. • , /" •, •,. '. - ', -",, ', ' '" '" -s` • ' ",,. i :, 'l ,•. -, .,, • . Z Yes 0 No • . STODGHILL FUNERAL HOME INC;500 E PARK ST HVVS'168, FORT BRANCH, IN 47648: - FH10900013 .. . ; . „ ••• :- k.• , 2 27b. Signature Of Indiana Funeral Service Licensee:' ' ' 27c..License Number(Ot.Licensee): ' ANDREA LYNN STODGHILL, BY ELECTRONIC SIGNATURE, •'>.,:•'- ,-,' . ••, ••, ; FD21400005 -, "- :( , ' •,'" -; •.': .-•••• •' - .,• Cause Of Death (See instructions And Exampfes) •.. • -.••.'' ' " '- Approximate .• '. . . 28;Part I.Enter The Chain Of Events -Diseaees,Injuries,'Or Complications That That Directly Ca:need-The'Death.Do Not Enter Terminal Events;' " . Interval: Onset' Such As Cardiac Arrest,Respiratory Arrest;Or Ventricular Fibrillation Without Showing The Etiology.'Dc-,Not Abbreviate Enter Only One Cause On , • . .ToDeath. A Line. Add Additional Lines If Necessary. ' "a •; `,. '• s•'„ = ;': ..,-: .•: . . , , .. ...".•: : ••• ''LESS,TFIAN ONE a -••, , , , , • . , • .,;'. • '•'• Irri'mediate Cauie(Final Disease Or Condition.Resulting In Death) A. :INTERNAL EXSANGUINATIONFROfARUPTURED ' AAA /. : . . , HOUR -• - ,/ ' • YEARS , . '•',••• ' ' •.•• ' ,-•.• - ••• `.',..' '-'-:• Sequentially List ConditionS, If Any Leading To The 13. rABDOMINAL•:•AORf IC ANEURYSM a. Cause Listed On•• . , ,,.„. .,. , •:-.- ,c, ....., : ,. •i ,o,.....,,,,ioi ..,Con,soquenco 0*, ,,, '' ' Line A.:Enter The Underlying Cause(Disease Or Injury That Initiated / . , • , - 7 '• .•, •' "The Events Resulting In Dea4' ' th)Lest '\ ; • •' C. " - ::-.'''•,„": '‘..:- •'- .: \'': ''.-• . 6.: , ", . ',. ' .... .,,;, -:..• , Due to(OT As e.Consequon.Of): :,."''' :: , „ , , • ' ':' i -; •'. • '.'.. .yr--1"-: S.'S' _.• ''..' \ " ' • . D. Z. ./.,' '' ....,-."'' : . •'/ Part II.Enter OtherSionificant Conditions Contributing to Death But Not,Resultring.,:lreTheUnirng..C1u7G.Jven In ....,,,:„.., 29,.,.W‘ass An Autopsy Performed? .;• "•,',,,,0 ys -- No, '; • '' .;-. , '''''' •"/ - 30 Weree-Autoosv Findina'Avallable To Complete The0 CauseOf Death? ' - """•''"•••'-'s . , ' ,' ' .,,,,,, F.,' .. ,,,s' -: , , ; •'...,,, .•. • - , ,• •., _;:..-..2, -• .•• ,,,,,:-•,, •,'-::: Yes.-.0 No \ " 31. Did Tobacco Use Contribute To Death? ... 32. If Female: '',- ",""..,',' .;" ...-, ' , e 33. Manner Of Death: '' ".. ' ., r . S.....: .... , ' , ,' , ,El Nol Pregnant Within ot Year ne I i01 oe 1 p,".tPr4nInt,Bur Pjeirnan!Wittlin 42 Dip Oftioalh IR Natura(10 Homicide Ej.Accthent 1:3,1?ending Investigation 0 Yes' '0 Probably ID No El Unknown ' ' . , .. '0 Not Pregnant.But Piognont 43 days To,1 year Before Do,th -.,,0" linjunvenitognoh1W,qhln 1.1,8 Pool'fur.,. "d Suicide 0 ob ‘uld‘NoiBebetermined -`..- , :•.s.• .: . .:•••- r , 34. Date Of Injury(Month/Day/Year) •'. ,• 35.Time Of Injury - -••:.. 36: Place'Otinjery(E.G/Decedent's Home:Construction Site;Restaurant,•Wooded Area).. - 37. Injury At Work? ' .; ..,.., ' . , , • ' •`' Dyes-'•-O NO'''• '-JAN'O.9.2020 ,-•,, ':,s:\. ''--s'' '`. - --'-'.: ' ---- -:.::'' - : ' -. ..; ; 38. Location Of Injury-State' . . . • 38a. City Or Town,. ',,.. 'i ' /38ti:Street&Number . ••:- -- ..• • -• " N• -,' ,•• -.:-:' ' ;., ' : •• , •,, "38c.'Apt.No. ,' "38d. 0,Code" - ,--, , ';, ';',„ ... ;--, •• , . . , r • )067; • -=: - ‘.• 1 1 '' .', ; "., % , ,:-1. r• , , . , •' 39. Describe How Injury Occurred • ' . ,40:If Transportation Initiry U , e.-cify:• _ ' ''' ''' •• I B$Q.NrC 0,U,NTY,AU D ITO R .,. .- .ElDrIvoriClperafor OPeasongor LIPadettrlan Othex(Spor.Ify) .a.', •' . 41.Signature,'Of Person Certifying Cause Of Death:, •:, '',., .: '...• ,...,' ''.. -;: ''.; ' . .' :..,, ' 42. Certifier(Check Only One), . '. '', . ... „ .,• ., S- RA AN A SEATON - : `.` '`P. > -.„• ... •,, BY,ELECTRONIC SIGNATURE :. \. ': , - ,0 Certifying Physician ::: 0 doronei-i ' 1U11:Hdelth,Officee; .•... \' .,.. .' 43. Name,Address And Zip Code Of Person Certifying Cause Of Death: . '', ' % % .' " ''' ' . 44. License Number ; : . • 45._Date Certified 'II,' ''. "..'-';'. ., ; '',"-"'- . : ' . .: '', .% • '.. • . ,. , 1 .,. • , .SARAH A BEATON ,#1 COUUNTY SQUARE'SUITE 115,.BOQNVILLE, IN /,47601 '•• -- ''-28.15494' ,:'. : ' ' •05/01/2017,-'' -, 46:Additienal Funeral Service Provider,-,,, ,,:, . .., , • .• , ,'.... EVANSVILLECREMATORY,.-•>\ . ,-. ', • . . .--- ----. 5.. -..::::../...- ----.-• s."..• . :--....-- . \ --. : ,-•. , -,-..--. ..- --. ----=,_ • • - .--,.,.. , - 48. Signature of Local Health Officer (:.-- ',.. .,..3 ...: , , ,• , •r;• ,-.„ •.• , ,',..: '-'• ,z,„' F,'••. .... ; -,,'• l•- ....,""'•.49';For Registrar Only,=Date Filed (MenthiDey/year),,:-,"•-, • ...,,,. •.'',...,- .-',..,-,, ' ' 17‘. '- RICKY-B YEAGER.,:-VIA ELECTRONIC SIGNATURE. : -,%:''-: ...`...%.::..T.:.,... --.-..-- "::: ' •".. •.-•::••= .. •: ';• .-. . ; •.. •,... ',"":"MAY.,-.0t 201'7 .';•.••- %:_•,, ?•-.-..- i '.'..,, T.‘ ",,,•,..' •::"":-:,0-'-,;---' -:-: -'', '•••-. - :••••••.':.-;• ,,•--.;•• ;•••••-,. "i=AMENpnwkiTyp,cER3-!Fic,mpF,•DevsH(gNITRY cmp5ca)ly_) ,•...1,...;; is.•1.-,.......,;.;:,-.,.....::-.;.... 1 .. AFENA. I.5' 4.. 5 ..1911. I N• .