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<br />STATE OF NEBRASKA
<br />WIAMP, :,rsa4GWGI1'NRap 149171iiis reflttYYlfPNyrt�; } /errryn n
<br />WHEN'THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKKA. IT CERTIFIES THE DOCUMENT BELOW TO
<br />BEA RUE COPYOF THE ORIGINAL RECORD ON FILE WITH 'THE NEB 'tASXA ;DEPARTMENT OF HEALTH AND
<br />HIJMAW SERWCESr VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />CA TE ISSUANCE
<br />348/2/124'
<br />•
<br />8
<br />202401499
<br />SARAH BOHNENkAIV
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND, HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />1..EEf,EDENTS NAME...(First, Middle, Last, Suffix)
<br />t JI Seph ) ran z
<br />CERTIFICATE OF DEATH
<br />4 CITYAND:SiATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand Island, Nebraska
<br />?:SOCIAL SECURITYNUMBER
<br />506.40*0805.
<br />5s. AGE • Last,B)ruida)i
<br />(Yrs.)
<br />88
<br />Sidi FACILITY -NAME -0f toot Institution, give street and number)
<br />CHI Health St, Francis
<br />$c 'QiTY OR'rOWN OF DEATH (Include Zip Code)
<br />Grand Island 88803
<br />9aiRESIDENCE STATE
<br />Nebraska
<br />9d;:sTREET00 NUMBER
<br />1920'4/il ::Charles Street
<br />9b. COUNTY
<br />Hall
<br />59. UNDER 1 YEAR
<br />MOS.
<br />DAYS
<br />$s. PLACE OP DEATH
<br />HOSPITAL a Inpatient
<br />p ER/outpatient
<br />❑ DOA
<br />10k.MAINTAE:BTATIA:AT TIME OF DEATH Ea Married 0 Never Married
<br />0 Married, but separated 0 Widowed 0 Divorced 0 Unknown
<br />11.FATHERS"NAME {First, Middle, Last, Suffix)
<br />toy Edward Kr,nz
<br />13 ;:EVER IN tl.S ARMEO'FORCES? Give dates of service if Yes.
<br />(Yes, No, orUnk.) No
<br />Sc: CITY OR TOWN
<br />Grand Island
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />HOURS
<br />MINS.
<br />24 434
<br />3; DATEOF'OSA f171arCk
<br />Februar5r 29;.2024
<br />OTHER 0 Nursing Hame/L'
<br />pDer edenrs Home
<br />0 Other (Specify)
<br />Sd. COUNTY OF DEATH
<br />Hall
<br />Be. APT. NO.
<br />Facility
<br />9f. ZIP CODE
<br />68803
<br />Job. NAME OF SPOUSE Middle, Suffix) . wife,
<br />Kathy Murphy
<br />12 MOTHER'S -NAME (First, Middle,
<br />Marr Catherine Boehl
<br />14a. INF)RMANT-NAME
<br />Kathy Kranz
<br />fN$IDE CITT:i,IMTS
<br />vEs , Q Ka
<br />Maiden Surname);
<br />14b. RELATIONSHIP TO;I
<br />Spouse
<br />15. METHOD OF POSITION
<br />E Sutial [,Donation
<br />Q Cremetlan Q Entombment
<br />QRamovat QOther(Specify)
<br />16a. EMBALMER -SIGNATURE
<br />Stacie L Cook
<br />18d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Grand Island City Cemetery
<br />17e, FUNERAL HOME NAME AND MA LING ADDRESS (Street, City or Town, State)
<br />All Faiths Fuorai;Home, 2929 S. Locust Street, Grand Island; Nebraska :
<br />16b. LICENSE NO.
<br />1495
<br />CITY / TOWN
<br />Grand Island
<br />CAUSE OF DEATH (6ee Instrudtons and examples)
<br />18c. DATE (Mo.,
<br />March 132._.
<br />1e. PART'. Enturt a chain of events- -diseases, injuries, or complications -that directly caused the death. DO NOT enter hominid events such as cardiac arrest,
<br />'.,respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add addhional lines If necessary.
<br />IMMEDIATE CAUSE:
<br />(final a) Acute respiratoryfailure
<br />Mulling
<br />Sequentially list conditions, If
<br />any, leading to the cause ested
<br />on fins a
<br />Enter the UNDE IYtNCCAVE.
<br />(dowse dr Irtf4lty that Ig4(lited
<br />the event* reeulfing in death)
<br />LAST
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b)Chronic obstructive pulmonary disease exacerbation
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />c)Covid 19
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)Acute kidney injury
<br />18 PART II OTHER SIGNBFFCANT CONDITIONS -Conditions contributing tithe death but not resulting )n thsunderiying cause given in PART I.
<br />Transltiened; to common cares
<br />to IF FEMALE: '-
<br />Noir gnantwMrtnpr
<br />PMgfiSnt.$ IhflC of death ,
<br />0' > Nat pregMnt but pregnant within 42 days of death
<br />0 Not pregnant, but pregnant 43 days to 1 year before death
<br />q.: Unknown if.pregnant vdtldn the past year..
<br />'C
<br />I DATE OF (NJURY (Mc:,, Day, Yr.)
<br />22d. INJURY AT WORK?
<br />❑ YES '❑ NO
<br />21a. MANNER OF DEATH
<br />® Natural O Homicide
<br />Accident ©. Pending ii#u*slgjtion
<br />0 Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />22c. PLACE OF IN
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />OOATION;OFINJUi Y STREET &NUMBER, APT.NO.
<br />23a. DATE oP DEATH (Mo., Day, Yr.)
<br />February 29, 2024
<br />CITY/TOWN
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />IMar01922024 ttel
<br />. Teti tars fleet ofnty knowledge, death occurred at the ti rts, date and place
<br />end due W Ste.;aause(s) stated. (Signatureand Tkb)
<br />Midtael A. Donner, MD
<br />29c. TIME OF DEATH
<br />09:59 PM
<br />25. DID TOBACCO USE CONTRIBUTE' TO THE DEATH?
<br />:0131 YES [] PROBABLY 0 UNKNOWN
<br />21b. IF TRANSPORTATION INJURY
<br />Q DriwanOperator
<br />Passenger
<br />• ❑ Pedestrian
<br />❑ Other (Specify)
<br />CRY 'A1 hcm6
<br />1t3IsrAS MEDICAL EXAMINER
<br />OR CO riepacONTACTED?•
<br />} C3 YE$ ®No
<br />21c. WAS AN AU Mi3PSY PERFORMC
<br />❑YEs INO
<br />21d. WERE AUTOPSY FINDS AMTO COMPLETE CAUSE OF DEA'
<br />El YES q 'NO,.. .....
<br />street, factory, office building, construction
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24b. TIME
<br />DEATit
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />544' be d e bale of examination and/or Investigation, In my-
<br />•
<br />thntiMa, date and place and due to the causets) stated.
<br />26a. HAS ORGAN OR TISSUE DONATIO.N,BEEN CONSIDERED?
<br />DYES:®NO
<br />27 NAME, 71TL E A ESS OF CERTIFIER (Type or Print
<br />Michael Ddrrner, MD, 729 North Custer Avenue, Grand Island, Nebraska, 68803
<br />NOUNCED DEAD
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable if 26e is NO OYES
<br />28b. DATE FILED BY REGIST
<br />March 14, 2024
<br />(I
<br />o., Day, Yr.)
<br />
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