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O57f o iti$l ompoi; r8I),(((51tes� *` x.}a ,gg4» 4.1. ffiidl.BD(tp c ,,,'.�,4-•tYPA'AVx?a o't:. "tR.f' aa�w... WHEN THIS i` COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE 4/17/2020 LINCOLN, NEBRASKA ro lit g P 2 4411, it v r m c 0 LC to 5 0 3 u Z' c m E VS , d al w w O S a s E re w. O ii g d p eiH O g 0 E a 202009605 5C4Ji 14t/Le 7, et:f* SARAH BOHNENKAMP ASSISTANT STATE REGISTRAR DEPARTMENT OF HEALTH AND HUMAN SERVICES STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES CERTIFICATE OF DEATH 1. DECEDENTS•NAME (First, Middle, Last, Suffix) Betty Arlene Renard 4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH Giltner, Nebraska 7, SOCIAL SECURITY NUMBER 507-64-9398 5a. AGE - Last Birthday (Yrs.) 92 Bb. FACILITY -NAME (If not institution, give street and number) 2408 West Louise Street 8c. CITY OR TOWN OF DEATH (Include Zip Code) Grand Island 68803 9a. RESIDENCE -STATE Nebraska 9b. COUNTY Hall 5b. UNDER 1 YEAR 2. SEX Female 5c. UNDER 1 DAY MOS. DAYS 8a. PLACE OF DEATH HOSPITAL ❑ Inpatient ❑ ER/Outpatient ❑ DOA 9c. CITY OR TOWN Grand Island HOURS MINS. 20 04707 3. DATE OF DEATH (Mo,,Day, Yr.) April 8, 2020 6. DATE OF BIRTH (Ileo., Day, Yr.) January 31,.;1928 OTHER 0 Nursing Home/LTC ® Decedent's Home 0 Other (Specify) I8d. COUNTY OF DEATH Hall 9d. STREET AND NUMBER 2408 West Louise Street Oa. MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married 0 Married, but separated 0 Widowed 0 Divorced 0 Unknown 9e. APT. NO. 91. ZIP CODE 68803 90. INSIDE CITY L(MtTS tE YES ❑ No 10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name Bobby Ranard 11. FATHER'S -NAME (First, Middle, Last, Suffix) Otto Clifton Hunnicutt 13. EVER tkl U.S. ARMED FORCES? Give dates of service if Yes. (Yes, No, or Unk.) No 112. MOTHER'S -NAME (First, Middle, Maiden Surname) Bessie Mav Detamore 14a. INFORMANT -NAME Bobby Ranard 14b. RELATIONSHIP TO DECEDENT Spouse 15. METHOD OF DISPOSITION ❑ BuNaI ❑ Donation ® Cremation 0 Entombment ❑ Removal ❑ Other (Specify) 16a. EMBALMER -SIGNATURE Not Embalmed 16d. CEMETERY, CREMATORY OR OTHER LOCATION Central Nebraska Cremation Services 17e. FUNERAL HOME NAME AND MAILING ADDRESS (Street, City or Town, State) Ap€ei Funeral Home, 1123 W. 2nd, Grand Island, Nebraska 16b. LICENSE NO. CITY / TOWN Gibbon CAUSE OF DEATH (See instructions and examples) 1e. PART I. Enter the chain of events- dl , Injuries, or complicationsdhat directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one amuse on a line. Add additional lines if necessary. IMMEDIATE CAUSE: IMMEDIATECAu$E(Pini a)End Stage Heart Failure diasap or Condition restating In death)G;: DUE TO, OR AS A CONSEQUENCE OF: Sequentially list conditions, If b) any, leading to the cause listed on wne e. DUE TO, OR AS A CONSEQUENCE OF: Enter the UNDERLYING CAUSE c) (disease or Injury dist Initiated the events resulting In death) LAST 16c. DATE (Mo., Day, Yr.) April 10, 2020 STATE Nebraska 17b,Zip Code 68801 APPROXIMATE INTERVAL onset to death ,: 1 Yeai' onset to death onset to death DUE TO, OR AS A CONSEQUENCE OF: d) 18. PART It. OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting In the underlying cause given in PART 1 onset to death 19. WAS MEDICAL EXAMINER OR CORONER CONTACTED/ ❑ YES ®NO 20. IF FEMALE: ❑ Not pregnant within past year ❑ Pregnant at time of death ❑ Not pregnant, but pregnant within 42 days of death 0 Not pregnant, but pregnant 43 days to 1 year before death ❑ Unknown 8 pregnant within the past year 22a. DATE OF INJURY (Mo., Day, Yr.) 21a. MANNER OF DEATH ® Natural ❑ Homicide 0 Accident 0 Pending Investtgation 0 Suicide ❑ Could not be determined 22b. TIME OF INJURY 21b. IF TRANSPORTATION INJURY 0 Driver/Operator 0 Passenger 0 Pedestrian ❑ Other (Specify) 21c. WAS AN AUTOPSY PERFORMED? ❑ YES NO 21d. WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE CAUSE OF DEATH? ❑ YES ❑ NO 22c. PLACE OF INJURY -At home, fern, street, factory, office building, construction site, etc. (Specify) 22d. INJURY AT WORK? YES ❑;NO 22e. DESCRIBE HOW INJURY OCCURRED 22f. LOCATION Of INJURY STREET & NUMBER, APT.NO. CITY/TOWN 73e. DATF. OF DEATH /Mo., Day. Yr.) S April 8, 2020 23b. DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH g u April 14, 2020 03:02 AM 1 w 3d. To the best of my knowledge, death occurred at the time, date and place and due to the commis) stated. (Signature and Title) in Ryan D. Crouch, DO STATE 24a. DATE SIGNED (Mo., Day, Yr.) 24b. TIME OF DEATH ZIP CODE 24c. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD 24e. On the basis of examination and/or investigation. M my opinion death XthtNW M the time, date and place and due to the cause(s) staled (Signature andT86e) .... 25. DID TOBACCO USE CONTRIBUTE TO THE DEATH? 0 YES El NO Q PROBABLY 0 UNKNOWN 26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? ❑ YES ®NO 26b. WAS CONSENT GRANTED? Not Applicable N 26a Is NO ❑ YES ©NO 27. NAME, TITLE AND ADDRESS OF CERTIFIER (Type or Print Ryan D. Crouch, DO, 800 N Alpha Street, Grand Island, Nebraska, 68803 28a. REGISTRAR'S SIGNATURE 28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.) April 14, 2020 Cr) 416 C)