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STATE OF NEBRASKA
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES, THE DOCUMENT BELOW TO
<br />BE A TRUE, COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKADEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE QFISBIIANCE
<br />2/2612024
<br />LINCOLN, NEBRASKA
<br />202401 0 33
<br />36t4 8d-/Uff
<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 />1. DECEDENT`S NAME (First, Mtddle, Last, Suffix)
<br />Abraham Gttbert Soto
<br />4 'CITY AND STATE OR;1'ERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Hastings, Nebraska
<br />S CfAL SECURITY NUMBER
<br />5€18-38-1116
<br />6a. AGE - LesttBlrthday•
<br />(Yrs.)
<br />.8 8b'FACILiTY4AME(It riot Institution, give street and number)
<br />A Veterans Affairs Medical Center
<br />8c. t1*OR T0WNQF Pape (Include Zip Code)
<br />Grand Island 688G3
<br />9a RESIDENCE_
<br />Nebraska
<br />9b. COUNTY
<br />Hall
<br />92..
<br />Sb. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />Be. PLACE OF DEATH
<br />HOSPITAL ®'Inpatient
<br />❑ ER/Outpatient
<br />❑ DOA
<br />9c. CITY OR TOWN
<br />Wood River
<br />HOURS
<br />MINS.
<br />3. DATE OF DF,ATH (liar., Day, V );
<br />February rit..1024g
<br />8. DATE OF BIRT . MO. Day; err )
<br />March 161, 193:1:
<br />OTHER 0 Nursing Home/LTC
<br />❑ Decedent's Home
<br />❑ Other (Specify)
<br />I8d. COUNTY OF DEATH
<br />Hall
<br />9d.;STREET ANMD NUMBER
<br />1 1:307 Dodd Street
<br />10s, MARITAL:STATflS AT TIME'OF DEATH El Married ❑ Never Married
<br />0 Married, but separated 0 Widowed 0 Divorced 0 Unknown
<br />FATHER S•NAME
<br />Jesus SDt4
<br />First, Middle,
<br />Last, Suffix)
<br />13 :EVER 1N U $ ARMEDFORCES? Give dates of service H Yes.
<br />(Yes, No, or Una.) Yes' 02/11/ 953-02/11/1955
<br />u 15. METHOD OF DISPOSITION
<br />fym.' Burial❑ l?rini)ion
<br />Cremation Entanbment
<br />QRethmra(<> ❑Qiher(Specify)
<br />9e. APT. NO.
<br />9f. ZIP CODE
<br />68883
<br />]NIRDEt.M PMTS
<br />®. YES C7 ;HO
<br />1Ob. NAME OF SPOUSE (First,Middle, Last, Suffix) If wife, give maiden mane
<br />Emily Galvan
<br />112. MOTHERS -NAME (First, Middle, Maiden
<br />Rosario Herrera
<br />14a. INFORMANT.NAME
<br />Emily Soto
<br />14b. RELATIONSHIP
<br />Spouse_
<br />DEC
<br />NT`
<br />16a. EMBALMER -SIGNATURE
<br />Gwen K. Hyronemus
<br />18d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />St. Mary's Cemetery
<br />17a FUNERAL HOME NAME AND MA LING ADDRESS (Street, City or Town, State),.
<br />Apfel Funeral Horne, 1123 W. 2nd, Grand Island, Nebraska •
<br />a
<br />16b. LICENSE NO.
<br />1448
<br />CITY /TOWN
<br />Wood River
<br />CAUSE OF DEATH (See instructions and examDies)
<br />13. PART I. Enter the chain of events• -diseases, Injuries, or complicatlons4hat directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />respiratory erreet, or veMncuiar fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a ane. Add additional lines if necessary.
<br />IMMEDIATE CAUSE:
<br />a) Failure to thrive
<br />-IMk1EDIATa CAuu*E (Fi tial
<br />disease or eeaditee resu ting
<br />1
<br />SegueMiilly list conditions, It
<br />any,.Ieading to the tauter listed
<br />->on lidte e
<br />EMO.rthe tJNDIELr11Ne CAUS
<br />(dheeeri eriNdiy'ihatkfi*ieted
<br />the events resulting in death)
<br />LAST
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b) Dementia
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />A 18, PART II OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting In the
<br />Heart iatlure' Sortie stenosis chronic anemia
<br />0. IF FEMALE:
<br />Q: Not pregnant wlahin past year
<br />Pregnant al4ime of ttaan:'
<br />Q i s
<br />❑.: Not pregrtaik, but pyeerent within 42 days of death
<br />0 Not pregnant, but pregnant 43 days to 1 year before death
<br />❑... unknown a:plgnent within ate past year
<br />• 22d. INJURY AT WORK?
<br />a ❑YES 0 N
<br />22f LOCATION OF INJURY STREET & NUMBER, APT.NO.
<br />21a. MANNER OF DEATH
<br />RI Natural ❑ Hornfcida
<br />0 Accident ❑ Pending Investigeaon
<br />0 Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY.
<br />18c. DATE
<br />Februarlt.21. 2024
<br />6881
<br />APPROXIMATE INTERVAL
<br />onset to death
<br />3 Months
<br />derlying cause given in PART!.
<br />21b,.IF TRANSPORTATION INJURY
<br />Drtfar/Operator
<br />`.� peseender
<br />❑ Pedestrian
<br />❑ Other (Specify)
<br />19. WAS MEDICAL EXfSMINER
<br />OR CORONER CONTACTED"'
<br />❑ YES ®NO
<br />21c.. WAS AN AUTOPSY PER
<br />DYES ElNO
<br />21d. RE AUTOPSY FINDINGS AVAlLAB1)h
<br />TO COMPLETE CAUSE OF_DEATH?
<br />❑ YES Q .NO .._
<br />22c. PLACE OF INJURY.At home, faun, street, factory, office building, constructions]
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />0.
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />February 13, 2024
<br />CITYWTOWN•
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />Febru#ry X1:4.2024
<br />23c. TIME OF DEATH
<br />12:10 AM
<br />2Sd. Tbthe bettor knowledge, death occurred at the time, data and place
<br />#n4 duik•NI s ceuaa(s) Stated. (Signature and Title)
<br />Jennifer Kind, MD
<br />26. DID TOBACCO USE CONTRIBUTE TO THE 4JDEATH?
<br />-.Ova `® NO El ESPROBABLY 0 UNKNOWN ❑ YES • IXJ NO
<br />27. NAME, T)TLE AND ADD S OF CERTIFIER (Type or Print
<br />Jennifer King, MD 2201 N Broadwell Ave, Grand Island, Nebraska, 68803
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />P
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24d. TIME PRONOUNCED DEAD
<br />2h. On the b.Ns of examination and/or Investigation, In my opirtiOn M
<br />thetttN. date and place and due to the causela)stated. (Signature
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />. REGISTRAR'S SIGNATURE
<br />‘01-44-nlZ I'Ll f7�;
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable If 28a Is NO LJ 1!t S
<br />•
<br />28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.) f
<br />February 20, 2024
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