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'c
<br />,if iAr
<br />4144»'::(filat Middle, Last, Suffix)
<br />Ther�etia' <ROWIe�+
<br />STATE OF NEBRASKA
<br />`set/4179:P.QC(OPptcD'; y„thYr���,S..,: _ 't'r,3G711a9Y1101�5F>: >'°tetjAy n,.!
<br />EN THIS COP ARRIi'<S THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELO
<br />E A TRUE. COPY...........ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN `,+ RVI S, wTA;. RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />202507181
<br />. = 1 n-4
<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 />CERTIFICATE OF DEATH
<br />AND STATE' OFtitiitRtTORY, OR FOREIGN COUNTRY OF BIRTH
<br />:L.ouP>City, Nebraslea>::.
<br />SOPr.IAL 6E9t f E TY iilllMEER
<br />5O6 72;_T85
<br />84 FACILITY-NAMnotlnstlh
<br />11
<br />a
<br />e
<br />et and number)
<br />DEATH Include Zip Code)
<br />Fl E1'ANi:itiilittii«#'>:'>;
<br />05 Howsid;Aven e'`
<br />9b. COUNTY
<br />Howard
<br />Rio, MARITAL STATUS AT TIME OP DEATH ® Married ❑ Never Married
<br />Married, butsepa►ated ❑Widowed © Divorced ❑ Unknown
<br />I FATlHERS-NAME first`"', Middle, Last, Suffix)
<br />. D l inic`< Willtarim'° .::Kuezak
<br />E1/ER IN U.S; ARMEDPQRCE$?
<br />Yee, Ng, or Unit.) N9
<br />ME.4 If3Q<RF;QiSPOS noN
<br />Oonotiort.
<br />'t r�nss;iun . enttm ittnitht
<br />Rehtotral Other (SP.cifY)
<br />Se. AGE - Last Birthday
<br />(Yrs.)
<br />69:
<br />Sb. UNDER 1 YEAR
<br />2. SEX
<br />Female
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />Sa. PLACE OF DEATH::.
<br />HOSPITAL ga Inpatient
<br />❑ ER/Outpatient
<br />Q::DOA..:
<br />9c. CITY OR TOWN
<br />HOURS
<br />MINE:
<br />3. DATE, OF
<br />August
<br />e. DATE OF
<br />OTHER ❑ Nyning Home/LTC
<br />❑ Decedent's
<br />❑ Other(Specffy)
<br />8d \COUNTY OF DEATH
<br />Douglas
<br />Be, APT. NO.
<br />10b. NAME OF SPOUSE (First, Middle, Last,
<br />W. ZIP CODE
<br />68873
<br />Suffix) If wife, give n)idd
<br />Michael Paul Rowley.:
<br />t2..MOTHER'S=NAME (First, Middle, Maiden Surname)
<br />Henrietta Michalski
<br />14a. INFORMANT -NAME
<br />Michael Paul Rowley
<br />ea. FUNERAL DIRECTOR SIGNATURE.:.
<br />Todd M Peters
<br />18d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services \
<br />FI I+lE ; i OMN t AME::ANP MAl1.2NG ADDRESS (Street, City or Town, State)
<br />Peters tbnefillIHOMC302 Second Street, PO Box 181, St. Paul; Nebraska
<br />1:8b. LICENSE NO.
<br />1078
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examples)
<br />s, injuries, or compiications that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />n Without showing the etiology. DO NOT ABBREVIATE. Enter Only one cause on stins/Add additional Ones x necessary.
<br />MEDIATE CAUSE:
<br />RA:lATEC USEna} `.;? , a)AcutO OCR chronic liver failure
<br />am.':c ndlitlan resuNfnpi:i : ..
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />aone,lf b)Cirrhosis
<br />uE TO, OR AS A CONSEQUENCE OF:
<br />a:UND
<br />a or Inlury
<br />hrnS in Qeathl DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />I. PART:I.I;:CTIER1214MFFICANT CONDITIONS.Condltion-contributing to the death but resultinin th:ik undS lying cause given in P
<br />kidney Injury, rieurtoendocrine cancer of the liver
<br />/.:epg
<br />Ncs pnegniEiti;i►Rgi)n
<br />Pa(t.it i.N:til'i
<br />:.,onioi snt, War pregnant within a2 days of death
<br />pnrgnanb bid Msansnr 45 daysto 1 veer before death
<br />fid'ownifptigitipe5ti Sin: .pastyesr
<br />t AT! N OF I
<br />tY!tiNtryDav, Y+.j,
<br />'!
<br />21a. MANNER OF DEATH
<br />Natural ❑ Hotnicitil): : .
<br />Accident ❑ PendinginvesEQation
<br />El"
<br />El Suicide ElCouldnot be determined
<br />22b. TIME OF INJURY
<br />22c. PLAC
<br />SCRIBE NOW INJURY OCCURRED
<br />TEEET4.NUMBER, APT.NO. CITY/TOWN
<br />DATE G 1EiATFI.(Ma,, 6ay,.Yr.)
<br />. Auputet.'I
<br />2025
<br />b..DATE SIGNED(MO., Day, Yr.) 23c. TIME OF DEATH
<br />AiuOU 23 202* 05:59 AM
<br />,..,a tb MMstotsnylrnOWsdge, death Occurred at the time, date and place
<br />Ealip to **Skillets) stilted. (5lgmaure and Title)
<br />Vogel, MD
<br />fiO`.i;>'Q:PiAgLY' UNKNOWN
<br />'`fooReSktorpe Ti fl IER (Type or Print
<br />IDy 4350 Dewey Ave, Omaha, Nebraska, 68105
<br />14b. RELATlO�j1HIP T1i OS
<br />SPOUae; '
<br />1Sc..fLtTEj
<br />Au ust
<br />ART 1. 111. WAS
<br />OR COIL
<br />yei
<br />21c. WAS AN AUTQPI
<br />Cl YES
<br />21d. WERE A
<br />TO COMP
<br />❑ YES
<br />INJURY -At borne,::farmstreet, factory, office building, conentat)
<br />.:21b.,:IR;TRANSPORTAT1ON INJURY
<br />Diiverioperator
<br />❑.Paiisenger
<br />❑ Pedestrian
<br />El Other (Specify)
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />244...PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME'OF I
<br />24d. TI
<br />2Ao,:pn die heaps of examination and/or Investigation, in my wan
<br />'the time; date and place and due to the cause(,) steNd: (Ei1
<br />26a. HAS ORGAN OR TISEtiE DONATION BEEN CONSIDERED?
<br />❑ YES :: No
<br />air.._...._.t-tom,1s4 .°�.aI- )
<br />28b. WAS CONS!
<br />Not Applicable If 2$s Is1D
<br />28b. DATE FILED SY
<br />August 22, 2025
<br />D
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