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1,,`,/yi 11,4 Tratt�tAuy+ } `raMf191t fa ?!.,: +1xty7sysp. 1ott5TAT' AAAA?�>. � ttrrllvAA11!(�y1',11at� laoNT x3 with WHEN THIS 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 OFISM/ANCE 12/21/2020 LINCOLN, NEBRASKA 202100289 \,7 ,a�� rit. d Os. If t<77 �vr k SARAH BOHNENKAMP j ASSISTANT STATE REGISTRAR DEPARTMENT OF HEALTH AND HUMAN SERVICES STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES 20 18122 Pursuant •to section 30-Z4 t3, demands far notice which may affect the estate of the deceased are tiled with the county court In the county where the decedent resided at the;time of death. - 1. DECEDENT'S -NAME (First, Middle, Last, Suffix) Janice Kay Frauen 2. SEX Female 3. DATE OF DEATH (Mo., Day, Yr.); December 11, 2020 4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH 5a. AGE - Last Birthday 5b. UNDER 1 YEAR 5c. UNDER 1 DAY 6. DATE OF BIRTH (Mo., Day, Yr.) Hastings, Nebraska (Yrs.) 86 MOS. DAYS HOURS MINS. October 25, 1934 7. SOCIAL SECURITY NUMBER 505-38-5001 8a. PLACE OF DEATH HOSPITAL fig Inpatient OTHER 0 Nursing Home/LTC ( Hospice Facility 8b FACILITY -NAME (If not Institution, give street and number) CHI Health St. Francis 0 ER/Outpatient 0 Decedent's Home 0 DOA 0 Other (Specify) 8c. CITY OR TOWN OF DEATH (Include Zip Code) Grand Island 68803 8d. COUNTY OF DEATH Hall 9a. RESIDENCE -STATE Nebraska 9b. COUNTY Hall 9c. CITY OR TOWN Grand Island 9d. STREETAND NUMBER • 420 Woodland Drive Be. APT. NO. 9f. ZIP CODE 68801 9g. INSIDE CITY LIMITS ® YES i NO 108. MARITAL STATUS AT TIME OF DEATH 0 Marded 0 Never Married ❑ Married, but separated ® Widowed 0 Divorced 0 Unknown 10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name Richard Frauen 11. FATHER'S -NAME (First, Middle, Last, Suffix) Albert Eugene Anderson 12. MOTHER'S -NAME (First, Middle, Maiden Surname) Pearl Bilveu 13. EVER IN U.S. ARMED FORCES? Give dates of service if Yes. (Yes, No, or Unk.) No 14a. INFORMANT -NAME Debra Kay McDermott 14b. RELATIONSHIP TO DECEDENT Daughter 15. METHOD OF DISPOSITION Burial Q Donation 16a. EMBALMER -SIGNATURE Not Embalmed 16b. LICENSE NO. 16c. DATE (Mo., Day, Yr.) December 15, 2020 ® Cremation 0 Entombment Removal 0 Other (Specify) 16d. CEMETERY, CREMATORY OR OTHER LOCATION CITY / TOWN STATE Central Nebraska Cremation Services Gibbon Nebraska 17a FUNERAL HOME NAME AND MA LING ADDRESS (Street, City or Town, State) All Faiths Funeral! Home, 2929 S. Locust Street, Grand Island, Nebraska 17b. Zip Code 68801" CAUSE OF DEATH (See instructions and examples) 18. PART I. Enter the chain of events- diseases, injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest, APPROXIMATE INTERVAL respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines H necessary. IMMEDIATE CAUSE: IMMEDIATE CAUSE float : al Acute Renal Failure ." ANNUM or condition resulting death) onset to death in DUE TO, OR AS A CONSEQUENCE OF: Sequentially list conditions, If b)Failure-To Thrive any, leading tothe cause. listed on fine a, ' onset to death DUE TO, OR AS A CONSEQUENCE OF: Enter the UNDERLYINOCAUSE c) Ischemic Stroke (disease or injury that Initiated onset to death the events resulting in death) DUE TO, OR AS A CONSEQUENCE OF: LAST d) onset to death 18. PART II. OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting in the underlying cause given in PART I. Coronary Artery Disease, Anemia 19. WAS MEDICAL EXAMINER OR CORONER CONTACTED?` ❑ YES ®NO 20. IF FEMALE: 0 N pregnant within past year 0 reena0 P ntal sterna o2 deathassen 21a. MANNER OF DEATH ® Natural 0 Homicide Accident ❑ Pending Investigation 21b. IF TRANSPORTATION INJURY ❑ Driver/Operator 0 Passenger g 21c. WAS AN AUTOPSY PERFORMED? ❑ YES ® NO 0 Not pregnant, but pregnant within 42 days of death ❑ Not pregnant, but pregnant 43 days to 1 year before death ❑.. Unknown if pregnant within the past year 0 suicide 0 Could not be determined 0 Pedestrian 0 Other (Specify) 21d. WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE CAUSE OF DEATH? 0 YES 0 NO 224. DATE OF INJURY (Mo., Day, Yr.) 22b. TIME OF INJURY 22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction site, etc. (Specify) 22d. INJURY AT WORK? [YES E] NO 22e. DESCRIBE HOW INJURY OCCURRED 22f. LOCATION OF INJURY STREET & NUMBER, APT.NO. CITY/TOWN STATE ZIP CODE B jr, 23a. DATE OF DEATH (Mo., Day, Yr.) December 11, 2020 To be completed by CORONERS PHYSICIAN or COUNTY ATTORNEY ONLY 24a. DATE SIGNED (Mo., Day, Yr.) 24b. TIME OF DEATH I e , I0 z 23b. DATE SIGNED (Mo., Day, Yr.) December 15, 2020 23c. TIME OF DEATH 07:20 PM 24c. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD 0 B tad. To the test of My knowledge, death occurred at the time, date and place and due tattle causes) stated. (Signature and Title) Manoi Suryanaravanan, MD 24e, On the basis of examination and/or Investigation, In my opinion death occurred et ::; the time, date and place and due to the eause(s) stated. (signature And Title)1.2 25. DID TOBACCO USE CONTRIBUTE TO THE DEATH? CI YES El NO 0 PROBABLY ® UNKNOWN 26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? ❑ YES El NO 26b. WAS CONSENT GRANTED? Not Applicable if 28a Is NO ` ❑ YES' 0 No 27, NAME,. TITLE AND ADDRESS OF CERTIFIER (Type or Print Manoj Suryanarayanan, MD, 2620 W Faidley Ave, Grand Island, Nebraska, 68803 28a. REGISTRAR'S SIGNATURE �� 1-7 8 CtriaDecember 28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.) 16, 2020 0)