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STATE OF NEBRASKA
<br />WF}EN THIS COPY CARRIES THERAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />gE A TRUE COPY O•
<br />F THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN°SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE
<br />4/11'/2022
<br />LINCOLN, NEBRASKA
<br />202202838
<br />SARAH BOHNENKAMP
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERTIFICATE OF DEATH
<br />1814994
<br />1. DECEDENT'S -NAME (First, Middle, Last, Suffix)
<br />Ronald flay Ludwig
<br />4. CI1Y ANb STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Storm Lake, Iowa.
<br />7. SOCIAL SECURITY NUMBER
<br />478-521065
<br />5a, AGE - Last Birthday
<br />(Yrs.)
<br />75
<br />O:.
<br />w
<br />E
<br />8b. FACILITY -NAME (If not Institution, give street and number)
<br />CHI Health. St. Francis
<br />1. 8c. CITY OR TOWN OF DEATH (Include Zip Code)
<br />Grand Island 68803
<br />9a. RESTDENCESTATE
<br />Nebraska
<br />here the deci
<br />9d. STREET AND NUM FIER:
<br />1404 West 1Itft Street
<br />9b. COUNTY
<br />Hall
<br />10a. MARITAL STATUS AT TIME OF DEATH E Married 0 Never Married
<br />0 Married, but separated 0 Widowed 0 Divorced 0 Unknown
<br />11 FATHER &NAME (First, Middle, Last, Suffix)
<br />Arnold J_'Lutkwiq
<br />13.'EVERIN LLS. ARMED FORCES? Give dates of service If, Yes.
<br />(Yes, No, or Unk.) No
<br />15. METHOD OF DISPOSITION
<br />EBurial ❑Donation
<br />CrematIott ❑ Entombment
<br />❑?tiemovat ❑ Other (Specify)
<br />SID. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL ® Inpatient
<br />^^ ❑ ER/Ou patient
<br />❑ DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />3. DATE OF DEATH (Mo.,.Day,
<br />November 18, 2018
<br />8. DATE OF BIRTH.IMo„ Day, Vr )
<br />September 7, 1943
<br />OTHER ❑ Nursing Home/LTC
<br />0 Decedent's Home
<br />❑ Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />9e. APT. NO.
<br />9f. ZIP CODE
<br />68801
<br />90,.INSIDE CITY 'LIMITS::
<br />YES [ :NO
<br />lob. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name
<br />Cheryl Kruse
<br />14a. INFORMANT -NAME
<br />Cheryl Ludwig
<br />16a. EMBALMER -SIGNATURE
<br />Gwen K. Hyronemus
<br />12. MOTHER'S -NAME (First,
<br />Irma Schaefer
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Westlawn Memorial Park Cemetery
<br />17a. FUNERAL HOME NAME AND MA LING ADDRESS (Street, City or Town, State),,,,
<br />Apfel f=uneral Home; 1123 W. 2nd, Grand Island, Nebraska
<br />16b. LICENSE NO.
<br />1448
<br />Middle, Maiden Surname)
<br />CITY / TOWN
<br />Grand Island
<br />CAUSE OF DEATH (See irtstruCtlons and examples)
<br />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,
<br />respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary.
<br />IMMEDIATE CAUSE:
<br />IMMEDIATE GAUB1 IFinaf a) Pneumonia
<br />disease or condition resulting
<br />In death) DUE TO, OR AS A CONSEQUENCE OF:
<br />Sequentially Iletconditions, It b) CerebrovascularAccident
<br />any, leading to the cause listed
<br />on line a.
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />EMer:the UNDERLYING CAUSE c)
<br />(disease or injury tttat irlidatail
<br />the events resulting in death)
<br />LAST
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />18. PARTtt. OTf1ER SIGNIFICAN
<br />Chronic Malnutrition .
<br />T CONDITIONS -Conditions contributing to the death but not resulting, in the Underlying cause given in PART I.
<br />14b. RELATIONSHIP TO DECEDENT:::
<br />Spouse
<br />16c. DATE (Mo.,Day, Yr )
<br />November 27.2018
<br />STATL
<br />•
<br />Nebraska
<br />17b. Zip Code
<br />6880-1 :.
<br />APPROXIMATE INTERVAL
<br />onset to death::
<br />2 Weeks
<br />onset to death
<br />One Month
<br />onset to death
<br />19. WAS MEDICAL'EXAMINER
<br />OR CORONER CONTACTED?_ " •
<br />❑ YES ENO
<br />20. IF FEMALE:.
<br />❑ ;Not pregnant within past year
<br />,pregna>% at time of death
<br />D
<br />❑'Neu pragnapt;' but pregnant within 42 days of death
<br />fl Not pregnant. but pregnant 43 days to 1 year before death
<br />❑ :Unknown if pregnerg.within the past year
<br />22a, DATE OF INJURY tMoDay, Yr.)
<br />c'
<br />22d. INJURY AT WORK?
<br />❑YES NO
<br />ri
<br />21a. MANNER OF DEATH
<br />E Natural D Homicide
<br />0 Accident 0 Pending investigation
<br />0 Suicide 0 Could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />0 Driver/Operator
<br />Q Passenger
<br />DPedestrian
<br />❑ Other (Specify)
<br />21c. WAS AN AUTOPSY PERFORMED?
<br />❑ YES E NO
<br />21d. WERE AUTOPSY FINDINGS AVAILABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES 0 N
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction site, Bt0. (Specify),;
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />172. 22f LOCATION OF INJURY STREET 8, NUMBER, APT.NO.
<br />2: •
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />November 18, 2018
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />November 19, 2018
<br />CITY/TOWN
<br />23c. TIME OF DEATH
<br />10:00 PM
<br />23i1 Tit tha beat of my knowledge, death occurred at the time, date and place
<br />and dueto the causes) stated. (Signature and Title)
<br />Gary Settle, MD
<br />25. DID TOBACCO USE CONTRIBUTE TO THE DEATH?
<br />0 YES E NO ❑ PROBABLY 0 UNKNOWN
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />ZIP CODE a:
<br />24b. TIME OF DEATH
<br />24d. TIME PRONOUNCED DEAD
<br />24e. On the basis of examination and/or investigation, in my opinion death otcurredat
<br />the time, date and place and due to the cause(s) stated. (Signature and TNIe)
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑ YES NO
<br />27. NAME, T1TLEAND ADDRESS OF CERTIFIER (Type or Print
<br />Gary Settle, MD, 2116 W Faidley #400, Box 9802, Grand Island, Nebraska, 68803
<br />28a. REGISTRAR'S SIGNATURE
<br />Amended
<br />1/2/2019 Item 12 Corrected First Name Emma To Irma
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable if 28a Is NO 0 YES
<br />28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.) I
<br />November 26, 2018
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