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STATE OF NEBRASKA •
<br />660ti111IQItIAt ;� rrttthf#N# 3 k541 ' Cl00 444r4W
<br />SEN 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 NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />< DATE OFISSUAl$tiCE
<br />' 3i'712�2•�
<br />LINCOLN, NEBRASKA
<br />202401643
<br />SARAH BOHNENKAM
<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. E7ECEDENTB NAME (First, Middle, Last, Suffix)
<br />Lindell ;Eugene ;::Hoffman
<br />4. CITYAND STATEOR•TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Iashington:
<br />7 .SOCIAL- SECURITY NUMBER
<br />805.84-4345
<br />8b.'FACILITYNAME (If trot Institution, give street and number)
<br />Veterans Affairs Medical Center
<br />CITY OR TOWN OF DEATH (Include Zip Code)
<br />rand island 68863
<br />9a RESIDENOE-STATE
<br />Nebraska
<br />>STREET ANID NUMBER
<br />1301.V'14th St
<br />9b. COUNTY
<br />Hall
<br />a. AGE - Leet Birthday
<br />(Yrs.)
<br />80
<br />Bis: UNDER 1 YEAR
<br />MOS.
<br />8a. PLACE O)= DENfitIM
<br />HOSPITAL .I /;:inpatient OTHER 0 Nursing HOm<G
<br />❑`ER/Oupatient 0 ❑'Decedent'sHa
<br />DAYS
<br />2. SEX
<br />Male
<br />Sc. UNDER 1 DAY
<br />HOURS
<br />MINS.
<br />3. DAT! OF itEAT# (May Day�,Yr.)
<br />FelsruaaYlt2024
<br />8, DATEOF BIR'€H:01(, DxlytY ).
<br />Oa MARITAL >STATUS AT TIME OF DEATH LE Married 0 Never Married
<br />0 Marded, but separated 0 Widowed 0 Divorced 0 Unknown
<br />I ATTER S !TAME (Flrat,
<br />Leonard Huffman
<br />Middle, Last, Suffix)
<br />13' EVER IN U S ARMED FORCES? Give dates of service If Yes.
<br />(Yes, No, orUnk.) Yes 08/26/1964-08/25/1967
<br />.'METHOD OP DISPOSITION
<br />films!• ©Dstion
<br />Cremation ❑ Entombment
<br />131Removal` ❑Other (Specify)'
<br />9c. CITY OR TOWN
<br />Grand Island
<br />0 Other (Spa
<br />(
<br />8d. COUNTY OF DEATH
<br />Hall
<br />Be. APT. NO.
<br />9f. ZIP CODE
<br />68603
<br />lob. NAME OF SPOUSE (First, Middle, Last, Suffix)
<br />Kay Schickedanz
<br />12. MOTHER'S -NAME (First, Middle, s. Maker'
<br />Doris Jugert
<br />14a. INFORMANT NAME
<br />Kay Hoffman
<br />16a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />18d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Westlawn Memorial Park Crematory
<br />16b. LICENSE NO.
<br />714;:FUNERAI1:1OME NAME AND MAIUNG ADDRESS (Street, City or Town, State)
<br />L vintxsta &Sondermann Funeral Home, 601 N. Webb Road, Grand Island, Nebraska <.
<br />a
<br />PART I. E
<br />of
<br />respiratory Smit, a car
<br />rgoardlaly jatConditons, if
<br />hy, leading to the cause listed
<br />t'irne a
<br />Enterthei4NOE „WIN..CAtJsI
<br />IdIeuae or in jury that AAiiteted
<br />s resulting in death):.
<br />CITY / TOWN
<br />Grand Island
<br />CAUSE OF DEATH (See instrudtions.and examples)
<br />l
<br />February
<br />lees, injuries, or complications4hat directly caused the death. DO NOT enter terminal events such es ardiac arrest,
<br />r Dalton without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional Stas N necessity.
<br />IMMEDIATE CAUSE:
<br />a) Hepatocellular carcinoma
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b)
<br />E TO, OR AS A CONSEQUENCE OF:
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />PART IL OTHER $IGNIFICANT'CONDITIONS.Conditions contributing to the death but not resulting. In the Underlying cause given In PART ).
<br />Diabetes ritsiiltUS, history of Agent Orange exposure
<br />IF FEMALE::
<br />Ntdpregmaitt ***past,yar
<br />PregnantaElbta df death
<br />Hot prepeat)t, but pretpant within 42 days of death
<br />Nit pregnant, bUt pregnant 43 days 101 year before death
<br />Unknown If pregnant within the petit year
<br />22a::DAT OF )NJUR ,l/60 r Day, Yr.)
<br />" 22d. INJURY AT WORK?
<br />id ❑ YES Q NO
<br />2:
<br />0
<br />21a. MANNER OF DEATH
<br />® Natural 0 Homicide
<br />❑ Accident ❑ Pending Inuestlgation
<br />0 Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />22c. PLACE OF INJURY.A
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />TION OF INJURY STREET & NUMBER, APT.NO. CITY
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />February 17, 20244;
<br />23b. DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH
<br />February ,22.2024; 03:52 PM
<br />23d, To the bast of my imowiedge, death occurred at the time, date end place
<br />and due to the taw(*) Stated. (Signature and Title)
<br />Jennifer King, MD
<br />21b IF TRANSPORTATION INJURY
<br />OHver/Operator
<br />',, ❑, Passenger
<br />Pedestrian
<br />❑ Other (Specify)
<br />ome,
<br />19.
<br />21c. WAS AF
<br />0 YES
<br />21d. WERE AUTOI+S'S PI
<br />TO COMPLETE OA
<br />0 YES 0;1
<br />arm, eat, factory, office building, conattuction
<br />2& L ID TOBACCO USE CONTRIBUTE TO THE DEATH?
<br />❑ YES : PROBABLY 0 UNKNOWN
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />Zee, On the basis of examination and/or Investigation, in myt
<br />Willow, date and place and due to the causes) slated,'
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑ YES NO
<br />:..NAME 'r TLAAND ADDRESS OF CERTIFIER (Type or Print
<br />JennNer ingr.MD, 2201 N Broadwell Ave, Grand Island, Nebraska, 68803
<br />as.`REGISTRAR'S SIGNATURE
<br />*lb. WAS CCM
<br />Not Applicable If
<br />28b. DATE PILED BY REGII
<br />February 28, 2024
<br />)
<br />
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