Eugene Donald
HOTTINGER
December 19, 1999
contributed by Ron
Renquin
STATE OF WISCONSIN
DEPARTMENT OF HEALTH AND FAMILY SERVICES
ORIGINAL CERTIFICATE OF DEATH
STATE FILING DATE JAN
10 00 045448
STATE DEATH NO.
LOCAL FILE NUMBER 6170
1. DECEDENT'S NAME First
Full Middle Last
Eugene Donald HOTTINGER
2. SEX
M F
X
3. SOC SEC NUMBER OF DECEDENT
394-30-0790
4a. PRONOUNCED DEAD DATE
Mo
Day Yr
December 19,
1999
4b. HOUR:
Hour
6:18
A M
5. BODY FOUND
24+ hours after death
Y
X N
6a. AGE (Years)
(Last Birthday)
65
b. Under 1 yr.
Mos
Days
c. Under 1 day
Hours
Min
7. DATE OF BIRTH Mo. Day
Yr.
May 20, 1934
8a. COUNTY OF DEATH
Milwaukee
8b. DEATH OCCURRED INSIDE
CITY, VILL.
TOWNSHIP
Milwaukee
8c. (CHECK ONE)
City
Vill. Twnship
X
9. DEATH AT HOSPITAL
1. Inpat.
3. DOA-From Nur. Hm.
5. DOA-From Other
2.
Outpat. 4.
ER-From Nur. Hm. 6.
ER-From Other
10. OTHER PLACE
N.H.
Other
X Res. of deceased
11a. HOSPITAL (AND CAMPUS) OR NURSING HOME
(If not in Hospital or Nursing Home give street address)
1775 South Pearl St.
11b. NURSING HOME
LICENSE NO.
12. MARITAL STATUS
X Married
Never Married
Divorced Widowed
13a. RESIDENCE - STATE
Wisconsin
13b. RESIDENCE - COUNTY
Milwaukee
13c. RESIDENCE - INSIDE CITY, VILLAGE, TOWNSHIP
Milwaukee
13d. (CHECK ONE)
City
Vill. Twnship
X
14a. NUMBER, STREET
1775 South Pearl St.
14b. ZIP CODE
53204
15. STATE OF BIRTH (Country if not in U.S.)
Wisconsin
16. FATHER'S NAME First
Middle Last
August Rudolph Hottinger
17. MOTHER'S NAME First
Middle Birth Surname
Alice
Juergens
18. RACE (e.g. White, Black, Am. Indian, etc.)
White
19. HISPANIC ORIGIN? Specify Cuban, Mexican, etc.
X No
20a. USUAL OCCUPATION (Do not enter "Retired")
Police Officer
20b. KIND OF BUSINESS / INDUSTRY
City Police Department
21. EDUCATION Highest grade completed
Elem/sec (0-12) College
(1-5+)
2
22. DECEDENT EVER IN U.S.
ARMED FORCES?
X YES
NO
23. SURVIVING SPOUSE (If wife, give birth surname,
not married surname)
(First, Middle,
Last)
Karen Kleinow
24a. INFORMANT'S NAME
Karen Hottinger
24b. MAILING ADDRESS Street
City/Village
State
ZIP
1775 South Pearl St. Milwaukee
WI 53204
25. METHOD OF DISPOSITION
Entomb.
Burial Cremation Donation
X
26. PLACE OF DISPOSITION (Name of cemetery, crematory,
or other place)
Arlington
Park Cemetery
27. LOCATION City/Village/Township
State
Greenfield
WI
28. DATE SIGNED BY FUNERAL SERVICE LICENSEE
(Mo., Day,
Yr.)
December 20,
1999
29. DATE RECEIVED FROM MED. CERT.
(Mo., Day,
Yr.)
December 29,
1999
30a. FUNERAL SERVICE LICENSEE (or person acting
as such)
Signature Susan Cram
30b. WI LICENSE NO.
5088
31. NAME AND MAILING ADDRESS OF FACILITY
(Street and
number, City, State, Zip)
Krause Funeral
Home
9000 W. Capitol
Dr., Milwaukee, Wisconsin 53222-
32.
MEDICAL
CERTIFIER
(Check one)
CERTIFYING PHYSICIAN -
To the best of my knowledge death was
pronounced and occurred
at the time(s) and due to the causes stated.
X CORONER/M.E. - On the basis of examination
and/or investigation,
in my opinion, death was
pronounced and occurred at the time(s) and
due to the causes and
manner stated.
33. DATE OF DEATH (Mo., Day, Yr.)
Dec. 19, 1999
34. AUTOPSY PERFORMED?
YES
X NO
35a. MEDICAL CERTIFIER SIGNATURE & TITLE (Black
Ink)
J M Jentzen
35b. DATE SIGNED (Mo., Day, Yr.)
Dec. 22, 1999
36a. MEDICAL CERTIFIER'S NAME
Jeffrey M. Jentzen, M.D., Medical Examiner
36b. WI. PHYSICIAN LICENSE NO.
C/ME code
40
37. CERTIFIER'S MAILING ADDRESS (Street &
Number, City, State, ZIP)
933 W. Highland
Ave., Milwaukee, WI 53233
38. MANNER OF DEATH
1. X Natural
4. Homicide
2. Accident
5. Undet.
3.
Suicide 6.
Pending
39. DATE OF INJURY (Mo., Day, Yr.)
40. HOUR OF INJURY
M
41. PLACE OF INJURY (Home, Street, Farm, etc.)
Specify
42. INJURY AT WORK?
YES
NO
43a. LOCATION Street or RFD, City or Vill., and
State in which injury occurred
43b. COUNTY
44. REGISTRAR SIGNATURE
Seth F Foley
MD CHO
45. DATE RECEIVED BY REGISTRAR (Mo., Day, Yr.)
JAN - 4 2000
46. PART I. Enter the diseases, injuries
or complications that caused the death.
Do not enter
the mode of dying such as cardiac or respiratory arrest, shock
or heart failure.
List only one cause of death on each line. Do not list old
age or senility
as sole cause.
(Final disease or condition
Interval between
resulting in death.)
onset and death
IMMEDIATE CAUSE
(a) PROBABLE SUDDEN CARDIAC
DEATH
- - -
Sequentially list conditions if
any, leading to immediate
cause. ENTER UNDERLYING
CAUSE LAST. (Disease or
injury that initiated events
resulting in death)
(DUE TO OR AS A CONSEQUENCE OF)
(b) ARTERIOSCLEROTIC HEART DISEASE
- NATURAL CAUSES
- - -
(DUE TO OR AS A CONSEQUENCE OF)
(c)
(DUE TO OR AS A CONSEQUENCE OF)
(d)
PART II Other significant conditions
contributing to death but not resulting in
underlying cause given in Part I.
CARCINOMA OF LUNG AND
ESOPHAGUS
47. IF INJURY, DESCRIBE HOW INJURY OCCURRED
* The entries have been transcribed exactly from the
original so that any
misspelling or errors of a person's name, place
name, date, or any other
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