Death Certificate - Stunkel, Herbert_12/13/2022 im
14:'`n:4t,f INDIANA STATE DEPARTMENT OF HEALTH
1:1 f:, CERTIFICATE OF DEATH 3 917 0 66
LOoal"'NO 000745 EDR No 000011418693 State No 2022-046238
1.Decedent's Legal Name(First,Middle,Last) 11,li 1a. Malden Name (II female) 2.Gender 3. Time 01 Death
Herbert William Stunkel
5. Social Security Number 6a. Age-Yrs fib. Under 1 Year Bc. Under 1 Month-8d. Under 1 Day 8e. Under 1 Hour
A Hospital
0 Hospice Facility 0 Decedent's Home 0 Nursing Home/Longterm Care Facility
I&Yes 0 No'0 Unknown ® Inpatient 0 Emergency Department Outpatient 0 Dead on Arrival CI (Specify)
P - it.
11. Facility Name (II Not Institution.Give Street and Number)rirr Deaconess Gateway Hospital
12. City Or Town,State,And Zip Code 13. County 01 heath 14. Marital Status At Time Of Death
Newburgh,Indiana 47630 Warrick' ty-.-�I Marr led❑Marred,am separated ®Divercned
g 'UI,II',' • Uh LJ Witlowad ❑Never Married ❑Unknown
15. Surviving Spouse's Name 15a.Lest Name Belpre First Marriage 16. Decedents Usual Occupation 17. Kind 01 Business/Industry
Farmer Agriculture
b'
18,,Residence-Slate 18e. County III 18b. City Or Town ;,;.'
IN Vanderburgh Evansville
i
18c. Street And Number Ili Ill, led. Apt.No. 18e. Zip Code 18f.Inside City Limits?
4540E 1300 S , 47725 ❑Ves ®No
19. Decedent's Education „,c• 20. Decedent Of Hispanic Origin 21. Decedent's Race ,
High School graduate or GED completed Not Spanish/HisparrtVLatino White
22.Parent's Name(First.Middle,Last) 23.Parent's Name(First,Middle,Last) 23a.Parent's Last Name Before First Marriage
' Wilbur Stunkel Nelda Stunkel McCutchan
24.Informant's Name 24a.Relationship To Decedent 24b.Mailing Address (Street And Number,City.Stale.Zip Code)
Steven Stunkel Son 4540 E 1300 S.Evansville,IN,47721"")
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„I, 25.Place Of DlspoalnonL1
25a.Method 01 Disposition 25b.Place Of Disposition (Name O1 Cemetery,Crematory,Other Place) 25c.Location-City,Town,A ate
❑Burial ®Cremation 0 Donation 0 Entombment ,I
❑Removal From Stale St.Stephens Cemetery Haubstadt,IN D E D 1 !.r 2D2Z
❑Other(Specify):
26.Was Coroner Contacted? 27.Name And Complete Address 01 Funeral Facility 27a. Funs Home License Number'
Stodghill Funeral Home Inc ul•
p Yes ®No 500 E Park Street,Fort Branch,Indiana,47648 H1090-0/013
27b. Signature 01 Indiana Funeral Service Licensee: „�,. 27c. Liter.ny(��,. -nwLi w
-,clirdrea£7(/iey ip,w, Electronically Signed GIBS( ,I�.COUNITIWO IV:ORM
Cause Of Death (See Instructions And Examples) Approximate
28.Pert I.Enter The Chain Of Event@ -Diseases,Injuries,Or Complication-That Directly Caused The Death.Do Not Enter Terminal Events Interval: Onset
Such As Cardiac Arrest,Respiratory Arrest,Or Ventricular Fibrillation Without Showing The Etiology.Do Not Abbreviate.Enter Only One Cause On To Death
A Line. Add Additional Lines I1 Necessary.
Immediate Cause(Final Disease Or Condition Resulting In Death) A. cardiopulmonary arrest due to acute on chronic respiratory failure with hypoxia 3 days
bee m la A.A eeeeese.sa oil
bilateral pneumonia with bilateral patchy opacities with suspicion for organizing 3 days
Sequentially List Conditions, 11 Any,Leading To The Cause Listed On B. Doe teia As Aee,e.m en.,on:
Line A. Enter The Underlying cause(Disease Or Injury That Initialed aspiration neumonitis orpneumonia with recent COVID-19 viralpneumonia 3 days
The Events Resulting In Death)Last C. P p y
It...re or Ar A cero.,weno.a,
D. acute on chronic diastolic heart failure exacerbation 3 days
Part II.Enter Other Significant Conditions Contributing to Death But Not Restating In The Underlying Cause Given In Part I 29. Was An Autopsy Performed? 0 Yes MI No
i atrial fibrillation with rapid ventricular response 30.Were Autopsy Finding Available To Complete The Cause Of Death? ❑yes 0 No
31. Did Tobacco Use Contribute To Death? 32. If Female: • 33. Manner Of Death:
0 eo, ..nm,wm.e Peal V . 0 e,..n..mcr n-or O.am 0 ear e.slrsaaVef er,ennn Cull'.42 Day.Of Ninth ®Natural 0 Homicide ❑Accident ❑ Pending Investigation
❑Yes att Probably❑No ❑Unknown
0 not Pleases,.But Presn.n IS Days Te I year Berm,oe.m ❑Umnreil.Prpn.n Wallin Teo essf Vow 0 Suicide 0 Could Not Be Determined
34. Dale Of injury(Month,'Day/Year) 35. Time Of injury ,. 36. Place Of Injury(E.G.,Decedent's Home.Construction Site,Restaurant.Wooded Area) 37. Injury At Work?
❑Yes ❑No
38. Location Of Injury-State 38a. City Or Town ,I, 38b. Street&Number II; 38c. Apt.No. 38d. Zip Code
il,l i., ?III;,
39. Describe How injury Occurred 40. If Transportation Injury,Specify: ,
❑Devesoeenin ❑fsasee.t.r❑P.wa,ms Dome rse..:uyi
41. Signature.Of Person Certifying Cause 01 Death: II' 42. Certifier(Check Only One)
,Jaynes-'(cop Electronically Signed ®Certilyirtg Physician 0 Coroner 0 Hearth Officer
43. Name,Address And Zip Code Of Person Certifying Cause 01 Death: 44. License Number 45. Date Certified
James Alsop 600 Mary Street,Evansville,IN 47747 02005340A 08/22/2022
46. Additional Funeral Service Provider: 47. 'Akae:
48.Signature of Local Health Officer,.. 49. For Registrar Only -Date Filed(Month/Day/Year),
,022
�'clyB'YcnJer Electronically Signed (08/22/( V
AMENDMENT TO CERTIFICATE OF DEATH(ENTRY OR ORIGINAL) aV
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