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<br />,C._._._._.._..=. STATE OF NEBRASKA
<br />P1t�$'.ti4WiWLtrtosr:-- �.ea2' �\cRc..
<br />a t8447W11f f 5 a; s �„�.}oq� 4'44 i. '1,♦'R, :.C4!d3te �, ::t
<br />TAWaa£sr ti.
<br />MEN > THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BE A::TRUE COPY F THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN.SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />t
<br />DATE OP:ISSUANE
<br />• 5/1 5
<br />LINCOLN, NEBRASKA
<br />202503011
<br />giltpUt
<br />SARAH BOHNENKAMP
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OVHEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERTIFICATE..OF DEATH.
<br />1. oscaosN'r$•NAME (Ou•eot;:>.s.: Middle, Last, Suffix)
<br />Gerald : 'red'^'Stinderrneler
<br />4t CrrY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />.Vona,<Colorado
<br />SOCIAL SECURITYNUMBE
<br />5a. AGE • Last St ay
<br />(Yrs.)
<br />PLACE �F DEATH
<br />HOSPITAL 0;.Inpatient
<br />...
<br />Sb. FACILITY -NAME (If not Institution, give street and number)
<br />CHI Health StFran.cis.
<br />Sc. "CITYOR t0WN`O0 DEATH (include Zip Code)
<br />Graici":lalrid<:6881-j3:: <. z
<br />9a. RESIDENCE -STATE
<br />Nebraska
<br />lid STR IET AND NUMBER
<br />.:..•4315:Michigan Menge,.
<br />9b.COUNTY
<br />Hall
<br />10e. MARITAL STATUS ATTIME OF DEATH El Married Q Never Married
<br />Cl Married, but separated ❑ Widowed ❑ Divorced ❑ Unknown
<br />11:;:FATHER'S'NAiMEE:>'(Firs ::.Middle, Last, Suffix)
<br />fret/;` Sundertneler:::<.
<br />13. EVER IN'u:S. ARMED FORCES? Give dates of service if Yea.
<br />(Yes, No, or Unk) Yes 01/04/1951-10/29/1954
<br />15. METHOD QF DISPOSITION.,.
<br />eimid
<br />Cremation i. nto tbme it
<br />0 Removal ❑Other (Spedfy)
<br />5b. UNDER 1 YEAR
<br />MOS.
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />DAYS
<br />® ER/Outpatient
<br />GOA..:::
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />July 8, 19
<br />OTHER ❑ Nursing Home/LTC
<br />❑-Decedent's Home
<br />© Other (Specify)
<br />ed. COUNTY OF DEATH
<br />Hall
<br />Olt APT. NO.
<br />9f. ZIP CODE
<br />68803
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) if wife, give maiden name
<br />Nancy Sue Owens
<br />12.:MOTHER'SiNAME (First,
<br />Agnes nes Gsisinger
<br />14a. INFORMANT -NAME
<br />Nancy Sundermeier
<br />18a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />IBA . LICENSE NO.
<br />Middle, Maiden Surname)
<br />led. CEMETERY, CREMATORY OR OTHER LOCATION : ' CITY / TOWN
<br />Central Nebraska Cremation Services Gibbon
<br />11at2:FLINERAk.HOME.NAMEAND MAILING ADDRESS (Street, City or Town, Star)
<br />$ ApfilFurieral l4ome,l123 W. 2nd, Grand Island, Nebraska
<br />Ei CAUSE OF DEATH'[S'ee instructions and examples)
<br />it PART I. Enter thechein of events- diseases, injuries, or complicatlons4hat directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />espiretory arrest or� ventricular fibnllatkm without showing the etiology. DO NOT ABBREVIATE. Enter only one cause one line. Add additional lines If necessary.
<br />':;:}.MEDIATE CAUSE: •
<br />Ihif4EDIATECAUSE( l&-1!):cardiacarrest
<br />gi dNou. oteoOgkloniaitidtkip :: �,
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />Sequentially Ilet conditions, If b) ventricular
<br />tachycardia
<br />hyca rdia
<br />any, .Meding30ithicaulSgoled
<br />rrn
<br />3ae r.,.,.. .:.
<br />' ' .'QUE TO, OR AS A CONSEQUENCE OF:
<br />:;:Writer thR UNDERLYING:CAUSE <.:.:C()
<br />(disease or Injury that initiated
<br />the events resulting in ep,th) DUE TO,�OR AS A CONSEQUENCE OF:
<br />LAST .::.::. dj
<br />143 PA1
<br />NSW
<br />it. OTHERSIGNIFICANT CONDITIONS -Conditions contributing to the deathbut not'rsl
<br />of stroke, Coronary artery disease, chronic kidney disease
<br />'2Q::IF'.FEMEALE ...
<br />Nctpngnsatwiti in:paupwr: >:::
<br />Not prebnara, buttpregnah within 42 days of death
<br />❑ Not pregnant, but pregnant 43 days to 1 year before death
<br />UnknoWwifpmfMi!ntwithhi.F.Paut year
<br />3 Ii,aATEOfz I �JUIs;Y; M Dly,'Yr.)
<br />22d. INJURY At WORK?
<br />21a. MANNER OF DEATH
<br />El Natural ❑ HopiRlds
<br />❑ Accident ❑ PMding>hrveatlgIdon
<br />❑ suicide '13 Could not be determined
<br />22b. TIME OF INJURY
<br />22c. PLACE OFiNJURY-At
<br />225, DESCRIBE HOW INJURY OCCURRED
<br />ear ;LOCATION ON Or ;;. STREET ✓E NUMBER, APT.NO. CITY/TOWN
<br />23a, DATE OF DEATH (Mo., Day, Yr.)
<br />-. April 30, 2025
<br />23b„ DATE;SIGN:ED: (Mo., Day, Yr.) 23c. TOME OF DEATH
<br />Mali:1, 202 ` :. 05:43 PM
<br />3d. TO:flie *Not thy knttRMdge, death occurred at the time, date and place
<br />"1!f11t die!tothe cikn di(s) stated. (signature amines)
<br />Isaac J. Berg, MD
<br />ng In Ow underlying cause given In PART I.
<br />21�b7;, IFINANSPORTATION INJURY
<br />:W flrlwsrlQpentor :
<br />❑ Peaarnger
<br />0 Pedeetdan
<br />❑ Other (Specify)
<br />14b. NELATIC
<br />Spouse
<br />lac. DATE (Mo.;.(
<br />May 1; 202
<br />19, WAS MEDOO& E.XI
<br />OR CORONERS
<br />E. YES.
<br />21c. WAS AN AUTOPSY PERFORM
<br />❑ YES'
<br />21d. WERE AU
<br />TO COMPLE
<br />❑ YES
<br />firm street,' factory, office building, construction
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />:24cA PRONOUNCED DEAD (Mo., Day, Yr.)
<br />:24e..ON the bald/ Of examination and/or investigation, In my opinion
<br />die tinii .dita and place and due to the cause) stated (Signature'
<br />USE CQNTRIBU1'I) TO THE DEATH? 25a. HAS ORGAN:!L1R TISSUE DONATION BEEN.:CONSIDERED?28b. WAS CONSENT
<br />PROBABLY ❑ UNKNOWN/ ❑ YES b7 a Not Applicable
<br />images OF CERTIFIER (Type or Print /
<br />D,'/29 North Custer Avenue, PO Box 2339, Gram! Isla d, Nebraska, 68803
<br />
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