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<br />THIS ;:"':COPY CARRIES THE RAISED SEAL OF H FATE OF NEBRASKA, IT
<br /><CERTIFES ti E DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGNAL RECORD
<br />ON RLE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN ,LSERVICES, VITAL
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITA1 RECO ADS
<br />DATE OF ISSUANCE •
<br />to
<br />i✓
<br />RUSSELL FOSLER
<br />ISTANT STATE REGISTRAR
<br />EPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA • DEPARTMENT OF IIEA.TH AND HUMAN SERVICES
<br />CERTIFICATE OF DEATH
<br />1 DECEDENTS -NAME f>FIrbt, Middle, Last, Suffix)
<br />Gary Frank Voecks
<br />4 OITY.AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Creston NebraSk
<br />7. SOCIAL'SECURITY NUMBER
<br />508-36.4244
<br />Sb FA, !IJTY NAME ref nt# i fedtution, give street rend number)
<br />Clan Health:;St Franc
<br />ec. CITY OR TOWN OF DEATH (include Zip Code)
<br />Grand Island 68803
<br />9a' RESIDENCE4TATE
<br />Nebraska
<br />tld. rrses ANti l umasR
<br />3110 Brentwood Drive
<br />Bb. COUNTY
<br />Hall
<br />6a. AGE Last Birthday,:
<br />IYta )
<br />82::.
<br />6k, UNDER1 YEAR
<br />2. SEX
<br />Male
<br />Be. UNDER 1 DAY
<br />iw
<br />OATS
<br />Ba. PLACE OF DEATH
<br />HOSPITAL ® Inpatient
<br />O:;ERlOuipatient
<br />toe. MARITAL STATUSAT.TIME OF DEATH ® Married 0 Never Married
<br />[ Married
<br />bOtfleprifated& 0 Widowed 0 Divorced 0 Unknown
<br />11 FATHERS NAME (Mmt, Middle, Last, Suffix)
<br />Herbert Voecks
<br />EVER IN U•S;:ARM• ED FORCES? Give dates of service If Yes.
<br />(Yea; Nd ar Unit) Yes• :'01/21/1955-07/2611957
<br />1!i METHOD OF:;DISPOSITION
<br />❑ 8uriat D Deflation
<br />® Cremation 0 Entombment
<br />0Rem0ova1 . 0 Otber.(Specify)
<br />BC CITY OF)iTQWN;..
<br />AilGralid ISlarid':
<br />lab. NAME OF SPOUSE;,(First;
<br />Judith Ledesrna
<br />HOURS
<br />MINS.
<br />3. DATE OF DEATH (Ma,
<br />Janury 20, 2020
<br />S. DATE OF MIRTH;(M
<br />June 12,193'I ;f
<br />OTHER 0 Nursing HomaiLTC
<br />0 Deoedenrs Hong
<br />0 Other (Specify)
<br />(id. COUNTY OF DEATH
<br />Hall
<br />tie. APT. NO.
<br />Sf. ZIP CODE
<br />68801
<br />may, xr.)..
<br />isAltsoa citvt.itSrS
<br />rid yes 0 No
<br />Middle, Last, Suffix) If wife, give Maiden me
<br />12. MOTHER S NAME (First, Middle, Maiden Surname)
<br />Leona Schwanebeck
<br />14a. INFORMANT -NAME.::;
<br />Judith A )becks
<br />16a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />LICENSE NO.
<br />CITY t TOWN
<br />Gibbon
<br />11a. FUNERAL HOME NAME AND MAILING ADDRESS (Street, City or Town, State)
<br />All Faiths Funeral Home. 2929 S. Locust Street. Grand Island. Nebraska
<br />CAUSE OF DEATH Mee Instructions:and examples)
<br />12, PAJl.' L Et41er ter4 4IIain dfeii -diseases, inlunes, or complications -that directly caused the death, DO'NOtent t butnirtal etdrits such as card ls; crest,
<br />fyfptretafy artatf, or Nefltrituier f brliaaoe without stowing the etiology. DO NOT ASSREYN.VTE Ener only ane cause pita int Add addlkinet ihtea d necessary.
<br />IMMEDIATE CAUSE:
<br />IMMEDIATE CAUSE O rel :... a)Acute Hypoxic Respiratory Failure
<br />disease or condition resulting ,
<br />Segdsd l+Ny lint conditions.-
<br />arty leading touts cause listed:::
<br />en
<br />Enter the UNDERLYING CAUSE
<br />thea#:i 4r trtjury $tIt irdtrettd; <
<br />tip 've$s matetl41n death) •:::
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b)Community Acquired Pneumonia
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />18. PART II. OTHER SIGNIFICANT CONDITIONS•Conditions contributing to the death but not resulting In the underlying cause given in PART I.
<br />Septic Shocky Acute Myeloid Leukemia, Tumor Lysis Syndrome, Acute Renal Failure, Metabolic Encephalopathy
<br />2D.IFsEEMA. E
<br />o Nm pregnar rift In past year
<br />0 Pregnant at tints of death
<br />!tor Idol pr404r7t:wat to 42 days of death
<br />d
<br />NOt prsgnant, but pregnant:43days tel year before death
<br />titdcaown N pregnant wlhlnlhe past year
<br />22a. DATE OF INJURY (Mo., Day, Yr.)
<br />220 *. URYATNORifi
<br />vat'iNO
<br />22f. LOCATION OF I
<br />21s. MANNER OF DEATH
<br />® Natural 0 Homicide
<br />0 Accident 0 Pending Investigation
<br />Suicide 0 Denadttittedetembried
<br />22b. TIME OF INJURY
<br />211 IF.TRANSPORTATION INJURY
<br />❑ t)riVedoperetor
<br />0 Passenger
<br />EPedestrian
<br />0 Othe Iepecsyi
<br />moist to death
<br />-71
<br />21d. WERE AUTOPSY !=(AtD!NGS . ti.. LE
<br />TO COMPLWFE CAUSE OF DE4111?
<br />yin 0
<br />22c. PLACE OF INJURY -At home, farm, street, factory,-afllce building, conatfuglign Idle, etc.
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />URY - STREET & NUMBER, APT.NO.
<br />23a,DATE OF DFAT(i (Mo., Day, Yr.)
<br />Janda j 20, 2020
<br />23b: DATE SIGNED (Mo., Day, Yr.)
<br />January 24. 2020
<br />CITY/TOWN
<br />23c. TIME OF DEATH
<br />12:20 PM
<br />3d. To the best of my knowledge, death occurred at the time, date end place
<br />and due to the causes) stated. (Signature and Title)
<br />VihayjK SOON,: MD _'
<br />26. Did:T0BACCOUSE CONTRIBUTE TO THE DEATH?
<br />0 YES 0 NO 0 PROBABLY ® UNKNOWN
<br />2t1e DAVE
<br />o.,
<br />Yr.)
<br />PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24e. On the basis of ategtilleg011 and/or irnvsMg*Na, In ray'
<br />thetime, date and pipe and due to the sauMM) *Mew.
<br />26a. HAS GAN OR TISSUE. DONATION BE€NCONSIDERED?*
<br />0 YES
<br />17. NAME, TITLE AND AD6itESS bF CERTIFIER (Type or Print
<br />V)rlay
<br />K Stir MD, 2620 W Faidley Avenue, Grand Island, t el
<br />® NO
<br />26b.WAS NT Q
<br />Not Applicable If ata *NO O Yi
<br />A oftwasl a..
<br />ai ..Trip...
<br />28b. DATE FILED BY RESGI$TRAR(t4o r'Day, W)
<br />January 24,,2020,
<br />t'. 1 -
<br />
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