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<br />JrYiltlrihrl`111,F� +,tdlhrlt4G0A11t.Q.1Nt.
<br />STATE OF NEBRASKA
<br />��ater,44rArOdSrca ::. _.ea25419.I:if1•cs ::.�.,>,ta.59'CANdNo :,n`°.ratCd4lls�dlDrrSr>.•. °,�`yxGrnmrtcc:>
<br />PVC RRIES THE RAISED SEAL OF STATE OF NEBRASKA; IT CERTIFIES THE DOCUMENT BELOW
<br />BE 4 TRUE COPVOI THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMANSERVICES VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />a4r P0StircE
<br />611724
<br />LINCOLN, NEBRASKA
<br />202405524
<br />SARAH BOHNENKA
<br />ASSISTANT STATE REGISTR1
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERTIFICATE OF DEATH
<br />4 4E LN1.44#ME :(First, Middle, Last, Suffix)
<br />t{tdeari ' I&Iycr► Christ
<br />4,41 ANp' (TA*Oft TERif TOR
<br />ler, Nebrraska
<br />L sacuRITY<) u.
<br />I Y, OR FOREIGN COUNTRY OF BIRTH
<br />ER
<br />8Q FACILITY IAME.`(M, not Institution, give street and number)
<br />T:he t erica €.at Sagewood
<br />`CIT:Y:;OR ` OWN;;O)`::DEATH (Uclude Zip Code)
<br />^Grditsland 8803 .
<br />RESIDENCE.STA
<br />Nebraska .;.
<br />9b.000NTY
<br />Hall
<br />(t;5attievgiod Avenue
<br />AftITAL.:$l'ATUSATTime OF DEATH ❑ Married ❑ Never Married
<br />Married, but saparaed. ] Widowed 0 Divorced 0 Unknown
<br />ttst, ' Middle, Last, Suffix)
<br />twofer
<br />s
<br />OF LP.QSITION
<br />unst:' � . ""'Donation
<br />Enlambmont
<br />then (Specify)
<br />Ive dates of service if Yes.
<br />6a. AGE - Last Birthday
<br />(Yrs.)
<br />:97
<br />5b. UNDER 1 YEAR
<br />MOS.
<br />DAYS
<br />8a. PLACE:0F DEATH
<br />HOSPITAL 0.:In..psient
<br />❑ ER/Outpatient
<br />❑ DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />2. SEX
<br />Female
<br />5c. UNDER 1 DAY
<br />HOURS
<br />MINS.
<br />J
<br />6. DATE OF NOM
<br />OTHER ❑ Nursing Homaft.TO
<br />❑ Decedents Home
<br />® Other(Specl
<br />18d. COUNTY OF DEATH
<br />Hall
<br />Be. APT. NO.
<br />2
<br />9f. ZIP CODE
<br />68803
<br />f 0b. NAME OF'POUSE (First, Middle, Last, Suffix) If wife, gfvti
<br />Harold John Christ
<br />IZ MOTHER'$ -NAME (First, Middle, Maiden
<br />Katherina A Swiickard
<br />14a. INFORMANT -NAME
<br />Dwight Christ
<br />16a. EMBALMER -SIGNATURE
<br />Gwen K. Hyronemus
<br />16b. LICENSE NO.
<br />1448
<br />i6d. CEMETERY, CREMATORY OR OTHER LOCATION CITY / TOWN
<br />Columbus Cemetery Columbus
<br />OME:.NAME AND MAILING ADDRESS (Street, City or Town, Sti
<br />neral;HOME, 1123 W. 2nd, Grand Island, Nebraska.
<br />)
<br />CAUSE OF DEATH (See instructions and examples)
<br />nt'..+lessees, injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add addklonal lines M necessary.
<br />MEDIATE CAUSE:
<br />rfontraumatic intracerebral hemorrhage
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />saauen($ lly Nat aonctfgahs, U b)�
<br />aiigi lMflltlp t
<br />ftp;3lna�j
<br />En i.00*UNl9ERL tr4GCAiUSE
<br />(diaaMia otilifigy,thiiYinitietad
<br />the "sots r1auiting hr thin" DUE TO, OR AS A CONSEQUENCE OF:
<br />LAST ..... ..... ........... d)
<br />18 fAR1:lL::01`
<br />hypetlansita ,
<br />Chad Viet
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />c)
<br />DITIONS-Conditions contributing to the death but not resulting in the underlying cause given In PART L
<br />in 42 days of death
<br />43 days bat year before death
<br />21a. MANNER OF DEATH
<br />® Natural 0 Hardcide
<br />❑ Accident ❑ Pandingingeatigation.; :.
<br />❑ Suicide ❑ Could not be aetemtined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />El Dr ver:Operator
<br />0 Passenger
<br />© Pedestrian
<br />❑ Other (Specify)
<br />1
<br />16c.0 0E(I
<br />July8,
<br />19.
<br />214. WAS AN AUtfS1 iY#
<br />❑ YES:
<br />❑ YES
<br />22c. PLACE OF INJURY -At home: farm, street, factory, office building, cons
<br />32e .DESCRIBE HOW INJURY OCCURRED
<br />& NUMBER, APT.NO.
<br />H (Mo,, Day, Yr.)
<br />CITY/TOWN .. STATE
<br />(Mo., OAT, Yr.) 23c. TIME OF DEATH
<br />4, . 07:58 AM
<br />*ledge, death occurred at the time, date and place .
<br />atated. (Signature and Title)
<br />D;:k1SLE.S;OOFFrtt)BUTis TO THE DEATH?
<br />> lO, i;s❑ I'RQBABLY ® UNKNOWN
<br />ANP 4pRe$4.,OF CERTIFIER (Type or Print
<br />,A4D,:2>1.16 W Faidley #400, Box 9802, Grand Island, Nebraska, 68803
<br />lea. REGI$TR'AW*,;IfiG NATURE'
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />Qp 24c, PRONOUNCED DEAD (Mo., Day, Yr.)
<br />5
<br />26a. HAS ORGAN OR TISSUE DONATION
<br />❑ YES : e
<br />414-7a-
<br />BEEN CONSIDERED?
<br />:24e;:tY(t thYbasis of examination and/or Invsatigatlon, lit
<br />the.tims, date and place and die to the cause($ a
<br />26b. WA43 CO
<br />Not Applicable 11
<br />28b. DATE FILED
<br />June 14, 2024
<br />N
<br />Y
<br />FiicNltlt
<br />
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