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STATE OF NEBRASKA
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<br />WHEN ;CAIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BE A TRUE CORY 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 />DATE {F'ISSUAAfCE
<br />6/2/2112
<br />LINCOLN,' NEBRASKA«
<br />202306580
<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 />1. DECEDENT'S -NAME (First, Middle, Last, Suffix)
<br />Danny .Rae Arndt
<br />CERTIFICATE OF DEATH
<br />4 Y AND:STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Aurora, Nebraska
<br />7 SOCIAL SECURITY NUMBER
<br />507, 56-0340
<br />fib. 't*ACiLITY4tA1NE {NOM institution, give street and number)
<br />Veterans Affairs Medical Center
<br />Ba .CITY OR TON OF Dr ATH (Include Zip Code)
<br />,Ataritt Isfanid 68803
<br />911. RESIDENCE4TATE
<br />Nebraska
<br />so. STREET AND NUMieE(:
<br />1723 South BlaineStreet
<br />9b. COUNTY
<br />Hall
<br />18a. MARITAL STATUS AT: TIME OF DEATH Married 0 Never Married
<br />0 Married, but separated 0 Widowed 0 Divorced 0 Unknown
<br />11. FATHERS.I+IAME (Pits;, Middle, Last, Suffix)
<br />Ralph Arndt
<br />13, E11'ER IN U S: ARMED FORCES? Give dates of service if Yes.
<br />(Yes No, or Unk.) Yes 01/06/1966-12/12/1966
<br />18. METHOD OI DISPOSITtON
<br />[J BuHai Q DanaUon
<br />J, J Cremat1Dtl Q Entomion ent
<br />❑ Removal- ❑Other, (Specify)
<br />Ba. AGE - Leat Birthday
<br />(Yrs.)
<br />Ms: UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />Sc. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OFDEATH
<br />HOSPITAL ®Inpatient
<br />J ER/Outpatient
<br />0 DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />3. DATE OF oa.1H:tiao.Day i't )
<br />May 25, 2023
<br />OTHER 0 Nursing Hot<C
<br />0 Decedent's Home
<br />❑ Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />Be. APT. NO.
<br />9f. ZIP CODE
<br />68803
<br />J Hoeptce Faclfity,
<br />.INSII E OiTYLIMITS;'
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, giv
<br />Rebecca A Milligan
<br />14a. INFORMANT -NAME
<br />Rebecca A Arndt
<br />16a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />12. MOTHER'&NAME (First, Middle, Maiden Surname)
<br />Ona Bernice Budler
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION'
<br />Central Nebraska Cremation Services
<br />17*. FUNERAL:HOMt NAME AND MA LING ADDRESS (Street, City or Town, State) ;.
<br />Ffiiabk Mt ulsttiri Mortuarv, tic., 1404 L Street, PO Box 204, Aro
<br />Nebraska;;
<br />18b. LICENSE NO.
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEAT"i"t`(See itafl'uctona and examples)
<br />14b; RELATIONSHIP TO D
<br />Spouse
<br />tec. DATE tfdc„ Day
<br />Mav 26, 2123.
<br />NT
<br />1Tb ZipC>!
<br />66$1.$'::::
<br />ta. PART I. Enter the chair) of events- dtees$es,:inprnes, or complications -that directly caused the death. 0O NOT enter terminal events such as cardiac arrest,
<br />Migratory arrest. Or ventricular flbdtlatkonwithout showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary.
<br />IMMEDIATE CAUSE:
<br />a) Critical limb ischemia
<br />IMMEDtATWC
<br />dialEa aorOOnd
<br />in 40106 DUE TO, OR AS A CONSEQUENCE OF:
<br />Sequentldy 1101 conditions, If b) Peripheral arterial disease
<br />any, leading to Me Vauae listed
<br />en ibis a ...
<br />1Pinat >
<br />1 reatlltine
<br />OR ASA CONSEQUENCE OF:
<br />the ever
<br />'LAST
<br />reS
<br />n9:in.d
<br />1 &'A1kRT IL i}THER
<br />Htp txattuure .
<br />20. IFFEMALE
<br />0Not plagt am v/nhia West year"
<br />, iFMegnaat d time otdesat
<br />Q
<br />#iot.pngnant Dutpregnent wlthla 42 days or death
<br />Not pregna4k but pregnant 43 days to 1; year before deem
<br />❑ ynkttOwn N.Prsgnamwlgfkt the past year
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />APPROXIMATE IN
<br />onssttrta
<br />48 HOUR •'
<br />onset tb death
<br />Greater Than 1 Year
<br />ti
<br />onset 10 deattl
<br />!CANT CONDITIONS -Conditions contributing to the death tit nottesutttng Ir# theunderlying cause given in PART 1.
<br />22a. DATE OF LN3URYIM0.o PAY, Yr,):
<br />22d, INJURY At WORK?
<br />YES ❑ NO.
<br />21a. MANNER OF DEATH
<br />® Natural © Homicide
<br />❑ Accident ❑ Pending Imriseltigatien
<br />❑ Salado ❑could not be deatmined
<br />22b. TIME OF INJURY
<br />2104F. TRANSPORTATION INJURY
<br />o� DNv9NOpsrator
<br />0 Pe9eenger
<br />Er Pedestrian
<br />Q Other (Specify)
<br />18 WAS MEDICAL, EXAM)NER
<br />OR CORONER CONTACTED
<br />❑ TES Isli NO
<br />21c. WAS AN AUTOPSY P
<br />❑ YEs ®NO :
<br />21d. WERE AUTOPSY FINDINGS AVAILABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />Q YES Q: NO . .
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction;
<br />220. tiESCRMBE HOW INJURY OCCURRED
<br />22r LC}CAT)cNOFiH,I1IRYSTREETaNUMBER,APT.NO.
<br />'sat
<br />2311. DATE OFDEATH (Mo., Day, Yr,)
<br />May 25, 2023
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />May 2$ 2023
<br />CITY/TOWN.:
<br />23c. TIME OF DEATH
<br />04:15 PM
<br />3d TO Lim best Of my knowledge, death occurred at the time, date and place
<br />minuets td thecommis) :stated. 18Ignature and Tale)
<br />Jennifer King, MD
<br />DID TOBACCO USE.GONTRIaUTE TO THE DEATH?
<br />YES 12NO 0 PROBABLY 0 UNKNOWN
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />24d. TIME PRON(
<br />EDDEAD
<br />24q. Od the bpsis of examination and/or investigation, In my opinion dad t aribli
<br />die tims,'date and place and due to the causal') stated. (Signature and':f*e)
<br />0
<br />26a. HAS ORGAN OR TISSUE. DONATION BEEN CONSIDERED?
<br />0 YES Oa;NO
<br />27.<NAME, 'IiTI.E:AND ADt i?ESS OF CERTIFIER (Type or Print
<br />Jennifer King, MD 2201 N Broadwell Ave, Grand Island Nebraska, 68803
<br />28a. REGISTRAR'S SIGNATURE
<br />28b. WAS CONSENT GRAN TED?
<br />Not Applicable If 28a Is NO t3. TES"
<br />28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.)
<br />May 31, 2023
<br />
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