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STATE OF NEBRASKA
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<br />W#IEN 'rMIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW To
<br />BE A IThJE COFV OFTHE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, .VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORV FOR VITAL RECORDS
<br />DATE OP ISSUANCE
<br />6/17/2024
<br />LINCOLN, NEBRASKA.
<br />202402915
<br />3/1E4 8,44.144/f
<br />SARAH BOHNENICAM,
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />O ED.ENi'$'NAME; (First, Middle, Last, Suffix)
<br />Danny R Murphy
<br />CERTIFICATE O.F. DEATH
<br />C(TY AND ATATE.DR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />:Grand Island, Nebraska
<br />7 SOC(AL50040iTTNUMBEa
<br />50.58;355Q
<br />5a. AGE • Last Birthday
<br />(Yrs.)
<br />76;
<br />Sb: FACILITY -NAME (fl not institution, give street and number)
<br />CHI Health St Francis
<br />ev,c i? ce..T140000_ DEATH (Include Zip Code)
<br />Grand lsla468803
<br />9a. RESIDENCE -STATE
<br />Nebraska.
<br />913. COUNTY
<br />Hall
<br />5b: LINDER 1 YEAR
<br />2. SEX
<br />Male
<br />Sc. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL ;Inpatient
<br />❑ ER/Outpatient
<br />❑ DOA
<br />4:SiRBEYA0p Nu0130.R
<br />218 N Darr Avenue
<br />1O ,...MARrriiSTATUS AT TIME OF DEATH ❑ Married 0 Never Married
<br />0 Married, but separated Ea Widowed 0 Divorced 0 Unknown
<br />11 :F&*EWiillIAME (fcirst, Middle, Last, Suffix)
<br />Harold J Murphy
<br />13 E1rJR IN U.S ARMED FORCES? Give dates of service if Yes.
<br />(Yes, No, or Unk.) NO.
<br />15 METHOD QF I SPosmON
<br />Burigl l tronatlon
<br />110.:90704 00 0 Ento nbment
<br />gltairraViti' ❑Other (Specify)
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />3. DATE Of (DEATH (M
<br />MSV 13, 2C4>'
<br />6. DATE OF, piR1H(Mo liar,
<br />April 19,:=1949
<br />OTHER 0 Nursing Homo/LTC
<br />❑ Decedent's Home
<br />❑ Other (Specify),
<br />I8d. COUNTY OF DEATH
<br />Hall
<br />Be. APT. NO.
<br />9f. ZIP CODE
<br />68803
<br />•
<br />Hoepleet.... i;y
<br />/g1 1,$IDE C13
<br />YES
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give molder, MERE`
<br />Velma Martin
<br />112. MOTHERS -NAME (First, Middle, Maiden
<br />Florence . M Crawford
<br />14a. INFORMANT -NAME
<br />Cara Hunter
<br />16a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />16b. LICENSE NO.
<br />18d. CEMETERY, CREMATORY OR OTHER LOCATION CITY / TOWN
<br />Central Nebraska Cremation Services Gibbon
<br />17.,,,:fueeiw:thOmkoodie AND MAIUNG ADDRESS (Street, City or Town, State)
<br />Atift l * *neral Home, 1123 W. 2nd, Grand Island, Nebraska
<br />CAUSE OF DEATH (Seer
<br />instructions and examples)
<br />111PART I. EnterthechainotIWnts• .Mseases, injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac artist,
<br />nespketory arrest, er ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause one line. Add additional lines If necessary.
<br />MEDIATE CAUSE:
<br />a)F it
<br />setluenfidiy list Condition*, if
<br />anYf'ioniS1151Q,ttw cw a NKtei/
<br />E6Ar:S!.ff:UNEEE. YINtI IA.,IISB
<br />id(t 7itA orinju'iy`dtati'nitgted
<br />the events resulting in death)
<br />LAST
<br />thrive
<br />a" urs to with metastatic cancer
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />tfi)metastatic prostate cancer
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />18 ;PARTA OT#IER:RGNIFICANT CONDITIONS -Conditions contributing to -the death
<br />-20 : F VOAiLE.:::
<br />?Mat imlgnentwlihitt pircr:year
<br />:o Pragpanf at tknr ff 11151
<br />.t8ot pregtiatit bit pregnant Within 42 days of death
<br />0 Not pregnant, but pregnant 43 days to i year before death
<br />l+nkrwrmlr:pregflan$ n die Viet nWupest
<br />Cl::
<br />Eta. .,DATE ,oFO(JU
<br />(Mqi Day. Yr.)
<br />22d. INJURY AT WORK?
<br />YES;::>:::i.l
<br />t not resulting in the underlying cause given In PART I.
<br />21a. MANNER OF DEATH
<br />® Natural © Homicide
<br />❑ Accident ❑ Pending Investigation
<br />0 Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />22c. PLACE OF
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />STREET & NUMBER, APT.NO.
<br />DATE OF DEATH (Mo., Day, Yr.)
<br />May 13, 2024
<br />23b DATE SIGNED (Mo:, Day, Yr.)
<br />IaY 15, . O24
<br />2b. IF TRANSPORTATION INJURY
<br />© Driver/Operator
<br />0 Passenger
<br />Pedestrian
<br />❑ Other(Specify)
<br />Limos
<br />Na
<br />14b. RELATIOfia14P 14DECEDEN'T
<br />Daughter
<br />16c, a4t10!., D+ r, Yr )
<br />May 15' 4
<br />19, WAS MEMAL EXAM
<br />OR Cott CONTACT
<br />1X1 Yes. .# NO
<br />•
<br />21d. WERE AUTOPSY'11(NG$iAFtilllI,At>
<br />TO COMPLETE CAUSE OF DEATH?
<br />© YES C]
<br />NJURY-At home; farm, Street, factory, office building, con
<br />23c. TIME OF DEATH
<br />05:19 PM
<br />Rahe nail (RAW knowledge, death occurred at the time, date and place
<br />data to the'oauee(s) stated. (Signature and Title)
<br />anth Reddy Kothapalli, MD
<br />CO USE CONTRIBUTE TO THE DEATH?
<br />PROBABLY ® UNKNOWN
<br />21:NAii , T11'LE AND APPRESS OF CERTIFIER (Type or Print
<br />• Sr)kanth Reddy Kothapatli, MD, 2620 W Faidley Ave, Grand Island, Nebraska, 88803
<br />REGISTRAR'S SIGNATURE'
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b.
<br />ME OF 0
<br />24d. TIME PON
<br />24a.tai t libasis of examination and/or investigatIo /tn toy
<br />thetins, date and place end due to the cause(s)
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑ YES El NO
<br />TH
<br />28b. DATE FILED BY REOWIRA
<br />May 20, 2024
<br />:(Mo,, Oey, i(r.)
<br />
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