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<br />STATE OF NEBRASKA
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<br />WHEN i"N/S COP Y CARRIES THE` RAISED SEAL OF STATE OF NEBRASKA, fT CERTIFIES THE DOCUMENT BELOW
<br />BEA TRUE COPY OF 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 />I?ATE
<br />OP ISSUANCE
<br />5/27/2022
<br />LINCOLN, NEBRASKA
<br />02206048
<br />d44J ° ! i
<br />SARAH BOHNENKAMP r
<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 />1. DECEDENTS NAME (Pint, Middle, Last, Suffix)
<br />Kent Wiliam Redwine
<br />4. CITYAND STATE .OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand island, Nebraska
<br />7. SOCIAL SECURITYNUMBER
<br />506-94-1127
<br />5a. AGE - Last Birthday
<br />(Yrs.)
<br />b. FACILITY -NAME (N not institution,gir
<br />CH( HealthSt, Francis
<br />51
<br />6b. UNDER 1 YEAR
<br />MOS. DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL ❑ inpatient
<br />Bc GTY OR TOWN OF DEATH (Include Zip Code)
<br />GrBrtd lslaltd 68803
<br />8a, RESIDENCE -STATE'
<br />Nebraska :I
<br />ER/Ou patient
<br />0 DDA
<br />9b. COUNTY
<br />Hall
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />HOURS MINS.
<br />22 07172
<br />3. DATE OF DEATt!I (MO., O y,'
<br />May 16, 2022. .
<br />OTHER 0 Nursing HomtULTC
<br />❑ Decedents Home
<br />❑ Other (Specify)
<br />I8d. COUNTY OF DEATH
<br />Hall
<br />9c. CITY OR TOWN
<br />Wood River
<br />08004 Fah#iry
<br />9d. STREET AND NUMBER
<br />207 Green Street
<br />. APT. NO.
<br />9f. ZIP CODE
<br />68883
<br />8
<br />10a. MARITAL STATUS AT TIME OF DEATH 0 Married ❑ Never Married
<br />®j Married, but separated 0 Widowed 0 Divorced 0 Unknown
<br />11: FATHER S. N AME lPimt, Middle,'
<br />Wi liam
<br />E Redwine
<br />Suffix)'
<br />.100 g 91.1.? 4,IMIT33
<br />1 ❑w
<br />1Ob. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name
<br />Adrienne Hodtwalker
<br />12 MOTHER'S -NAME (First, Middle,
<br />I
<br />Beverly A Christensen
<br />Maiden Surname)
<br />13. EVER IN U.S ARMED FORCES? Give dates of service if Yes.
<br />(Yes, No, or Link.) NO
<br />OD OF,DISPOSIT4ON
<br />Buda CIDona#Ibn
<br />( Cremation; Q Entombment
<br />Q Removal 0 Other (Specify)
<br />14a. INFORMANT -NAME
<br />Adrienne Redwine
<br />6a. EMBALMER -SIGNATURE
<br />Brandon S Bachle
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Westlawn Memorial Park Cemetery
<br />170 I UNERALJ4.0 ME NAME AND.,MA imp:ADDRESS (Street, City or Town, State)
<br />Apfel Furt(?rai Hom , 1123 W 2nd, Grand Island, Nebraska
<br />18b. LICENSE NO.
<br />1537
<br />CITY / TOWN
<br />Grand Island
<br />14b. RELATIONSHIP TO DECEDENT`
<br />Spouse
<br />18c DATE (Mo, Da)i,`Yr`
<br />May 23,•
<br />2
<br />CAUSE OF DEATH (See instructions and examples)
<br />$'TATE`
<br />Neb
<br />1711 Zip;€
<br />688011
<br />18. PART 1. Enter the chain of events- .diseases, injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />respketory 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 />a) Blunt force injury of head and right Leg
<br />in death)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />Sequentially list conditions, if b) Motor: vehicle accident
<br />, le4ding to tha::ivsus4 Nsted
<br />DUE TO OR ASA CONSEQUENCE OF:
<br />EMerlhe ilM811140010MME c) ..
<br />(disease Or injury that Initiated'
<br />the events resulting le death) DUE TO, OR AS A CONSEQUENCE OF:
<br />LAST d)
<br />APPROXIMATE INTERVAL
<br />onsettodeath
<br />2 Houtz . .
<br />PART it OT}; ER SIGNIFICANT CONDITIONS -Conditions contributing to the ddath but not resulting litthe underlying cause given In PART L
<br />20. IFtFEMALE:.
<br />0 Not 9"snatst lttnpsst
<br />❑'Pregnant atdeadordean
<br />pregnant':but pregnant within 42 days of death
<br />❑-Not pregnant, but pregnant 43 days to 1 year before death
<br />Unknown Irpnsgnant withhl the past year
<br />22s ;DATEOF INJURY (MO.,':Day, Yr.)
<br />May 9 6, 2432
<br />21a. MANNER OF DEATH
<br />El Natural ❑ Nomktd l
<br />® Accident 0 Pending Investigation
<br />❑ Suicide
<br />--Could not be determined
<br />22b. TIME OF INJURY
<br />09:48 PM
<br />2111IF: TRANSPORTATION INJURY
<br />® Driver/Operator
<br />0 Passenger
<br />0Pedestrian
<br />❑ Other (Specify)
<br />old to death
<br />,,WAS laari)04.BXAMINsta ••
<br />;, 1
<br />OR CORONER CONTACTED?
<br />IZI YES ❑ NO
<br />21c. WAS AN AUTOPSY: PEI FORNIEV8
<br />El YES: ONO,
<br />21d. WERE AUTOPSY FINDINGS AVAILAlE
<br />TO COMPLETE CAUSE OF MATH?
<br />® YES ❑ NO
<br />22c. PLACE OF INJURY At ttorne, farm, street, factory, office building, constru
<br />22d. INJURY AT WORKS 22e. DESCRIBE HOW INJURY OCCURRED
<br />] YES NO Motor vehicle driver eastbound on Highway 30, near Burwick Road and decedent on motorcycle westbound on
<br />yy . Highway'ln Mntnr vahirla mnvad intdl wanthni Ind tants tn yaaA Annthar vahirip Mntnr vahirhii sand rlar dean fat
<br />YIP CODE
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<br />'r` 22f LOCATION OF INJURY STREET& NUMBER N APT O CITY/TOWN STATE
<br />UsH phwav 3,QVilest And South Burwick Road, Hall County. * Nebraska
<br />23a. DATE OF DEATH (Mo., Day, Yr.) 24a. DATE SIGNED (Mo., Day, Yr.) 24b. TIMEOF DEATH
<br />May 20, 2022
<br />E
<br />0.
<br />23b DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH
<br />334& To tare beef nt nt uknscowledge, death no
<br />end <due to ttte causes) stated. (Sigel
<br />25. DID TOBACCO. USE:eONTRIBUTE TO THE DEATH?
<br />YES 11NO ❑ PROBABLY, 0 UNKNOWN
<br />2.
<br />n:
<br />a Sarah Hinrichs, Hall Deputy County Attorney
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />Mav 16, 2022
<br />11:58 PM
<br />24d. TIME PRONOUNCED.DEAD
<br />11:58 PM
<br />24e, On the Reels of examination and/or investigation, In my opinion death der ufret at
<br />the dme, date and place and due to the -causes) stated:`
<br />1 (siPtatwsandTlllai..,;
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />E YES 0 N
<br />27, NAME 1TT • ANDAD ESS OF CERTIFIER (Type or Print
<br />Sarah Hinrichs,' Wali Deputy Gounty Attorney, 231 S. Locust, Grand Island, Nebraska, 68801
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable if 26a Is NO
<br />28a. REGISTRAR'S SIGNATURE
<br />r24}7 B.n
<br />28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.)
<br />May 23, 2022
<br />
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