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<br />STATE OF NEBRASKA
<br />(@er,,ryrttd&;t..'��::':;�'%tt4499i.'lir1.P1F
<br />igt444.79WIC(.Oft$sD:.:�.¢'ftrrmstdASScr�::::"'.,
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR ViTAL RECORDS
<br />C'
<br />S
<br />w`o
<br />STATE
<br />240. DATE SIGNED (Mo., Dey, Yr.)
<br />240:..PRONOUNCED DEAD (MO., Day, Yr,)
<br />24d, TIME
<br />24s.:On the bittlia di xaminadon and/or investigation, in my'opiniq
<br />thrii, ate end place and due to the Cause(s) stated. (sighs
<br />If if tD, 26a. HAS ORGAN ::OR;;TISSUE DONATION BESN.GONSIDERED?
<br />❑ YES NO
<br />NAME, :TITLE ANl A:Di E88 OF CERTIFIER (Type or Print
<br />,lennifer:Kingr.M . 2201 N Eroadweti Ave, Grand Island, Nebraska, 68803
<br />DATE OF ISSUANCE
<br />4/2412025
<br />LINCOLN," NEBRASKA
<br />202503965
<br />>OEGEDENT'$-NAIrlE"#First';: MFtldle, Last, Suffix)
<br />t.f#I OX ?:Jf hri Stegmnan
<br />4. CITY AND STATE OR It RY
<br />7, SQGIAL SEcU:tfTY NUMBER
<br />13434,7570
<br />ITO
<br />r h 134, f
<br />SARAH BOHNENKAMP
<br />ASSISTANT STATE REGISTRAR;
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERT.IFICAT ,QF DEATH:
<br />, OR FOREIGN COUNTRY OF BIRTH
<br />f
<br />tlb. FACiUTY-NAME (if not Institution, give street and number)
<br />`Veteran:ss Aflai;rs:Medical Center
<br />$C; Ci i? OR.1OW OF: DEATH::(Irlciude Zip Code)
<br />¢" Grand .litlarld:68803`'
<br />ga. RESIDENCE -STATE
<br />.:Nebraska
<br />Sd .S'IRRET:$D:NUMBE1:
<br />Sb. COUNTY
<br />Hall
<br />10e. MARITAL STATUS AT TIME OF DEATH ] Married 0 Never Married
<br />0 Married, but separated ❑ Widowed ❑ Divorced 0 Unknown
<br />1'tyFATHERi8-NAllfe (First,'"; Middle, Last, Suffix)
<br />Andr@vY';. ticiCr'an.:::;
<br />13. EVER IN U.S. ARMEDFORCES? Give dates of service if Yes.
<br />(Yes, No, or Unk) Yes 12/28/1954-12/13/1956
<br />1$: METHO;DOF DISPOSITION
<br />Cremation . `EntOmtiment
<br />0 Removal © Other (Specify)
<br />5a. AGE Last Birthday
<br />(Yrs
<br />91.
<br />Sb. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />Ba. PLACEOF DEATH::..:
<br />HOSPITAL ig Inpatient
<br />0 ER/Outpatient
<br />DDOA.:::;.
<br />9c. CITY OR ;OWN
<br />Giaii Island
<br />HOURS
<br />MINS.
<br />3. DATE OF t1BATBt:(
<br />April,$, Q? `
<br />OTHER Q Nursing Homo/LTC
<br />0 Decedent's Home
<br />0 Other (Specify)
<br />Sd. COUNTY OF DEATH
<br />Hall
<br />Bo, APT. NO.
<br />Sf, ZiP CODE
<br />68801
<br />/ 10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, (five malt
<br />.Bernadette Werth .
<br />12,MCIrHERS-NAME (First, Middle, MiddenSo
<br />Lucy SUlzman /
<br />14a. INFORMANT -NAME
<br />Bernadette Stegman
<br />15a. EMBALMER -SIGNATURE
<br />Patricia R. Curran
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Westlawn Memorial Park Cemetery
<br />1,70;:FU# ERAt HOME Ni :ME AND MA LING ADDRESS (Street, City or Town, State)
<br />:Curran Funeral C,t ape/; 3005 S. Locust St., Grand Island Nebra
<br />16b. LICENSE NO.
<br />CITY / TOWN
<br />- Grand Island
<br />CAUSE OF DEATH (See instructions and examples!
<br />is, PANT I. Eider the chain of�,-diseases, Injuries, or complicatlons4hat directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />respiratory arrest, or ventricular fibrillation without s'loyAhg the etiology. DO NOT ABBREVIATE, Enter only one cauee on a line. Add additional lines if necessary,
<br />:IMMEDIATE CAUSE:
<br />ir;v+eoiAtEcAVSElrinai:' :a?Myocardial infarction
<br />disease or condition ti*ultPbng
<br />in death) DUE TO, OR AS A CONSEQUENCE OF:
<br />Sequentially list conditions, it b1
<br />any,:leading to.thee cause IlstedI:
<br />an: Ana
<br />>'DUE TO, OR AS A CONSEQUENCE OF:
<br />Eller the *OEAL'f+NO CANOE'::. C)
<br />(disease or injury that initiated
<br />the events resulting in death)
<br />LAST QUEE TO, OR AS A CONSEQUENCE OF:
<br />18. PARt.II.:OTHERi:SIGNiFIGANT CONDITIONS -Conditions contributing to the dea
<br />History of subdural henatoma, Cold War injuries, anxiety neuroses
<br />/ •
<br />20 IF FE►AArt' E; :
<br />.:'DNntpregnanlwtitl.i .. ..
<br />,:,:tJ Pislii,"0.. ittnsof,
<br />-0 Not prspnant, brit pregnant wnhin 42 days of death
<br />0 Not pregnant, but pregnant 42 days to 1 year before death
<br />': unknown.4 pregnant w t[ in•the pest year
<br />ATE t INJURY
<br />IN,(VRY AT WORK?
<br />0Yes .0 No •
<br />;,Day, Yr.)
<br />but notreaultl
<br />21a. MANNER OF DEATH:
<br />Natural ID Homicide
<br />0 Accident 0 Peniding';investigatiod
<br />Suicide Could not be dstennined
<br />22b. TIME OF INJURY
<br />n the underlying cause given in PART I.
<br />21;b. IF TRANSPORTATION INJURY
<br />:CI DAvsr/Ojierator
<br />Paitsanger
<br />0 Pedestrian
<br />D Other(Spec)fy)
<br />IN
<br />14b. RELATIONSHIP
<br />SPOUSE ..
<br />DATE OAP.
<br />April 24.2
<br />1
<br />7iP
<br />PROx1MtA'
<br />0
<br />ii;;Da)r
<br />kS ME1DISAL;4EE, „ NO.
<br />OIRR CORONER t TA0
<br />t VES
<br />21c, WAS,ANAUT{ P$Y IY
<br />© YES
<br />21d. WERfiAl
<br />TO
<br />q YES
<br />22c. PLACE OF INJURY At home farm, :stfeet, factory, office building, coos
<br />22s. DESCRIBE HOW INJURY OCCURRED
<br />2f LQCATIQN OF INJUR Y :STREET & NUMBER, APT. NO. CITY/TOWN .:
<br />23e, DATE OF DEATH (Mo., Day, Yr.)
<br />April 16, 2025
<br />3#Y (DATE_SIGNED.{Mo., Day, Yr.) 23c. TIME OF DEATH
<br />>ADl l:'f )2 ::, 05:40 PM
<br />StX� TR.Shs bfft Gf:triy<kertiWkidoe, death occurred at the time, date and place
<br />arid A:i,WYe itte:aiiuile(s) stated, (Signature and Title)
<br />___Jennifer King, MD
<br />7fl IJSE cON`I'RIBUTE TO THE DEATH?
<br />ti PROBABLY UNKNOWN
<br />i
<br />28b. WAS CONS
<br />Not Applicable if 25e,is NO
<br />25b. DATE F
<br />April 21, 2025.
<br />
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