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<br />STATE OF NEBRASKA �)
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BE A TRUCOPY" OF TH EE 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 />of
<br />•3'
<br />DATE OF ISSUANCE
<br />3/24/2026
<br />LI.NCOLN, NEBRASKA
<br />202602839
<br />SAIRAH 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 />1 D DENT$4IAME (Ftf$t, Middle, Last, Suffix)
<br />Vicki Lee Pap1Fe' , \
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />1
<br />Omaha, Nebraska/
<br />T. SOCIAL SECURITY NUMII ER
<br />508-75-4773
<br />tab. FACILITY -NAME (If not Institution, give street and number)
<br />Grand Island Regional Medical Center
<br />6a SitY OR TOWN OF DEATH (Include Zip Code)
<br />Grand island 68803
<br />9a. RESIDENCE -STATE
<br />Nebraska
<br />Id. STREETANOt; NUMBER
<br />423 1 exas AVe
<br />9b.COUNTY
<br />Hall
<br />10a. MARITAL STATUS AT TIME OF DEATH ® Married ❑ Never Married
<br />❑ Married, but separated ❑ Widowed 0 Divorced 0 Unknown
<br />11 FATHERS NAME (Pint!:' Diddle, Last, Suffix)
<br />Ftidtatd gluey
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unk.) No
<br />1--METHOD OF OR{POSITh N
<br />8urfal [] Donatirat
<br />❑ Crematon 0 Entananent
<br />❑ Removal 0 Other (Specify)
<br />Se. AGE - Last Birthday
<br />(Yrs.)
<br />71
<br />8a. PLACE OF DEATH
<br />HOSPITAL ® Inpatient
<br />❑ ER/Outpatient
<br />0 DOA
<br />6b. UNDER 1 YEAR
<br />MOS.
<br />2. SEX
<br />Female
<br />6c. UNDER 1 DAY
<br />DAYS
<br />9c. CITY OR TOWN
<br />Grand island
<br />HOURS
<br />MINS.
<br />3. DATE OF DEA'E((Mo., NY. Yr
<br />March 11, 2026
<br />6. DATE OF BIRTH (Mo., Day, Yr.)
<br />May 17, 1954
<br />OTHER 0 Nursing Horne/LTC
<br />❑ Decedents Home
<br />❑ Other (Spica?)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />90. APT. NO.
<br />9f. ZIP CODE
<br />68803
<br />L� tlospk» Ftcipiy
<br />t,(WOEGI
<br />YES
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name \
<br />Harlen Papke
<br />14a. INFORMANT -NAME
<br />Harlen Papke
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Kelley D Sheridan
<br />12. MOTHER'S -NAME (First, Middle, Malden Surname)
<br />Margaret Wait
<br />18d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Westlawn Memorial Park Cemetery
<br />ITIL NERAL KOMS6 NAME'AND MAILING ADDRESS (Street, City or Town,.State)
<br />sepll faithS Funeral Haire, 2929 S. Locust Street, Grand Island, Nebraska
<br />16b. LICENSE NO.
<br />1439
<br />CITY / TOWN
<br />Grand Island
<br />CAUSE OF DEATH (See Instructions and examples)
<br />1S. PART I. Enter the chain of events• •disease., injuries, or complications -that directly caused the death. DO NOT enter terminal events such as carcase arrest,
<br />reePHaaly Greet. orwtWlfulw taMaation without showing the etiology. DO NOT ABBREVIATE. Enter only one,causeon _a tine. Add additional lines if necessary.
<br />IMMEDIATE CAUSE:
<br />atatED(ATE CAUSE IPMel a) Kidney cancer
<br />disease or conditionresulting
<br />In death)
<br />aaqueMial Ilet coAOltloln, 6
<br />any to the Causelleted;
<br />on HMO.
<br />Enter the UNDERLYING CAUSE
<br />(disease or hinny that Misted
<br />the events resulting in death)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />18. PART 0. SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting In the underlying cause given In PART I.
<br />Dementia, hypertension, type 2 diabetes mellitus
<br />2 . IF'FEMA1 E
<br />® NO(PCa9Mntw)dltitpeMyeia
<br />❑F mt et tin r of dram,
<br />❑ Not pregnant, but pregnant within 42 days of death
<br />❑ Not pregnant, but pregnant 43 days to 1 year before death
<br />uuiitndnlnl s pfepnanrwi to1M poet year
<br />22a. DATE OF INJURY (Mo Day, Yr.)
<br />22d. INJURY AT WORK?
<br />21a. MANNER OF DEATH
<br />Naturai ❑ Homicide
<br />❑ Accident ❑ Pending investigation
<br />❑ Suicide
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />Driver/Operator
<br />❑:Passenger
<br />❑ Pedestrian
<br />Other (Specify)
<br />14b. RELATIONSHIP TO DECEDENT
<br />Spouse ..
<br />16c. DATE (Mix* Day.
<br />March 16, 2626
<br />Nebraska.
<br />APPROXIMATE INTERVAL
<br />Malt t#01.N# : ....
<br />Months
<br />onset to death
<br />onset toalaNti
<br />19. WAS MEDIClkf:
<br />OR C N CORONER VTTA
<br />❑ YES ..:.:®
<br />:NQ
<br />21c. WAS AN AUTOPSY PERFORMED?
<br />❑YES
<br />4 ®NO
<br />❑could not be a.rermin.d 21d. WERE AUTOPSY FINDINGS AVAILABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />0/YES ❑ `(
<br />22c. PLACE OF INJURY -At home, fawn, street, \ ctory, office building, construction sit ,eta t8psd )
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />22fLOCATION OF INJURY STREET & NUMBER, APT.NO. CITY/TOWN
<br />ST4TE
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />March 11 2026
<br />236 DATE SIGNED..(Mo., Day, Yr.)
<br />March 12 2026
<br />23c. TIME OF DEATH
<br />09:45 PM
<br />22d Ta for beet O tmy knowedge, death occurred at the time, date and place
<br />an4lain to th esu.e(e) stated. (Signature and TEN)
<br />Chad Vieth, MD
<br />i�
<br />I
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />24d. TIME PRONOUNCED DEAD .
<br />24e. On the basis of examination and/or investigation, M my °PMien death DCCCanad et
<br />the time, date and place and due to the cause(*) stated. (Sigaeles Mitt 1111e)
<br />'I' DID TOSACCOUSECONTRIBUTE TO THE DEPTH? 26a. HAS ORGAN OR TISSUE
<br />DONATION BEEN CONSIDERED?
<br />YES NQ PROBABLY I UNKNOWN DYES 7
<br />27. WIT D O� ESS OF CERTIFIER (Type or Print
<br />Chad Vieth, MD, 2116 W Faidley #400, Box 9802, Grand Island, Nebraska, 68803
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable If 26a Is NO Q YES
<br />28b. DATE FILED BY REGISTRAR(Mo, Oay,
<br />March 18, 2026
<br />NO
<br />
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