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<br />STATE OF NEBRASKA
<br />srtf41711111tIi1>
<br />;;t2dGllilrlNl�t,- .,.
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA IT CERTIFIES THE DOCUMENT BELOW TO
<br />BEA TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HU�9AN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF VANDE
<br />;'x/'1602
<br />LINCOLN, NEBRASKA
<br />202207
<br />t
<br />SARAH BOHNENKAMP
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />TATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERTIFICATE OF DEATH
<br />t Di?OEDENT^a'»NAME (Fest, Middle, Last, Suffix)
<br />Diane Malaria Nowka
<br />4. CITY AND STATE **TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />9msb Nebraska .
<br />7. SOCI*SLOURITY NUMBER
<br />054242i
<br />5a. AGE - Last Birthday
<br />(Yrs.)
<br />67
<br />8b. lth YFNAME #if notlnst tudofy
<br />252 S. Oak St.
<br />Brest and:number)
<br />8c.' CITY OR TOWN OF. DEATh (Include Zip Code)
<br />Mand Island 801
<br />9a. RESIDENCE -STATE
<br />Nebraska
<br />9b. COUNTY
<br />Hall
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Female
<br />5c. UNDER 1DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL] Inpatient
<br />..�W
<br />0 ERIOu patient
<br />Q DOA
<br />9d. STREET Ai P: NUt4(BBR
<br />X52S OajiSt �
<br />18a. MARITAL.STATUlt AT TIME OF DEATH O Married 0 Never Married
<br />Married, but separated 0 Widowed 0 Divorced ❑ Unknown
<br />1. FAmER S:.N . G t#1: Middle, Last, Suffix)
<br />Dan Krupsk€
<br />13. EVER
<br />(Yea, No
<br />RMEr? FORCES? Give dates of service If Yes.
<br />15.
<br />scren,a%t
<br />0R a
<br />,t,:pis OSITION'
<br />jDonae an
<br />0Entombmest
<br />❑ Other (Specify)
<br />9c. CITY OR TOWN
<br />Grand Island
<br />19b. NAME OF SPOUSE (Fiat,
<br />Ed Nowka
<br />112 MOTHER'S -NAME (First,
<br />Helen Kurz
<br />9e.
<br />HOURS
<br />MINS.
<br />221 092;
<br />3. DATE OF DEATh (M'd., Daly Yr.):
<br />Found August 5, 2022
<br />6. DATE OF:BIRTH`.(190., Oay,lli:')
<br />May 22, 1s
<br />OTHER I) Nursing Home<
<br />® Decedent's Home
<br />0 Other (Specify)
<br />I8d. COUNTY OF DEATH
<br />Hall
<br />APT. NO. 9f. ZIP CODE
<br />68801
<br />Middle, Last, Suffix) If wife, gloom!
<br />14a. INFORMANT -NAME
<br />Ed Nowka
<br />48a, EMBALMER -SIGNATURE
<br />Stacie L Cook
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Grand Island City Cemetery
<br />17a.,FUNERAL:)HOM.:NAME AND MAILING ADDRESS (Street, City or Town, State)
<br />Alt Fait s ffune;rst dome, 2929'S Locust Street, Grand Island, Nebraska
<br />16b. LICENSE NO.
<br />Middle, Malden Surname)
<br />14b. ROLA
<br />Spt�u
<br />16c. DAI
<br />August
<br />CITY I TOWN
<br />Grand Island
<br />CAUSE OF DEATH (Set;:'tlstruotions and examples)
<br />I events•-dh6ssss, Injunas,:or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />itricular fdhdNation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause one line. Add additional lines if necessary.
<br />IMMEDIATE CAUSE:
<br />et (Final
<br />dNh qae a4°1"14441wauitiiny. `' ...
<br />In death} DUE TO, OR' AS A CONSEQUENCE OF:
<br />tlaquentiauylistcondMons' it b)Higliblood .pressure
<br />aegy, esssisp ttr the cause Hated
<br />a) Unknown Natural Causes
<br />UNDER YtN6 AUSE.
<br />IdIstaae.or Wiayittist initiated:::
<br />the events ireeetttna In death) DUE TO, OR AS A CONSEQUENCE OF:
<br />LAST • d)
<br />A' CONSEQUENCE OF:
<br />death
<br />1& PRRT1i t1Sfl.R$IGONIPICANT CONDITIONS -Conditions contributing to the death but notreeditingin the underlying cause given In PART I.
<br />2D IFIJ
<br />itltd luagestit sw6Tin I/oa!
<br />Aregnentdt thea of heath
<br />0,,,,:i,regnantowtorewiant within 42 days of death
<br />Q Not pregnant, but pregnant 43 day* to 1 year death
<br />rr--�i kIn(tnpwn Bittpeneat wttMn the past year
<br />215. IF TRANSPORTATION INJURY
<br />0 DAvarlOperator
<br />0 Passenger
<br />0 pedestrian
<br />0 Other (Specify)
<br />ohOett444Krfl 1
<br />19. WI
<br />OR
<br />NER OF
<br />® DEATH 21c, WAS Af
<br />0 YEs
<br />21d. WERE AU fCIINGS AVAIU
<br />TO COMPLETEMal OF DEAT1.1?
<br />❑ vas
<br />22c. PLACE OF INJURY•At home,farm, street, factory, office building, construction site, etc.:}1
<br />21a. MAN r'�
<br />Natural 1..3 Hom[Clde
<br />CI Accident 0 Pending Inveatlyetdn
<br />Suicide Could not be determined
<br />22b. TIME OF INJURY
<br />22e. DESCRIBE )IOW INJURY OCCURRED
<br />22f, LOCATION OF MIAOW :" STREET & NUMBER, APT.NO.
<br />23a, DATE OF DEATH (Mo., Day, Yr.)
<br />CITYfTOWN
<br />totmykna
<br />trMr the causeis)a
<br />ath occurred at the time, date and place
<br />ignMum and Title)..
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />August 11, 2022
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />AUGUSt 5, 2022
<br />24b. TIME OF DEATH
<br />Unknown
<br />24d. TIME PRONOUNCED DEAD:..;,:
<br />05;13
<br />24e. On the basis of examination andtor investigation, Maly opMiori
<br />the limo, date and place and due to the cause(s) stall. (Big
<br />Martin Klein, Hall Deputy County Attorney
<br />25. D.ID TOBAC0O USE CONTRIBUTE TO THE DEATH?
<br />YES NO PROBABLY ® UNKNOWN
<br />27.NAME, T)Tf:EANDADRESS OF CERTIFIER (Type or Print
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑ YES 1'I NO
<br />kilartirt,Ki' in, Hal(Deputy County Attorney, 231 S. Locust, Grand Island, Nebraska, 68801
<br />r._.
<br />28a, REGIS' 0'8 SIGNATURE
<br />26b. WAS CONSENT GRAITFE0?
<br />Not Applicable if 28a Is NO tijOtt
<br />28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.)
<br />August 11, 2022
<br />
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