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<br />SUM THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BEA TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMANSERV/CES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OFISSUANCE
<br />5/18/2026`
<br />LINCOLN, NEBRASKA
<br />202603785
<br />5M4"S‘titin
<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 />1. DEOEDENTS4' AME (First Mldde, Last, Suffix)
<br />Dianna SOO Vass'
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand island, Nebraska
<br />7 SOCIAL SEC1liitTY N. UlMi bER
<br />508454.33O1 -
<br />5a. AGE - Last Birthday
<br />_ (Yrs./
<br />78
<br />I b. FACILITY -NAME (If not Institution, give ebest and number)
<br />306 Vlfainw:rlgh.t
<br />8c. CITY OR TOWN OF DEATH (Include Zip Code)
<br />Grand island 68801
<br />9a, RESIDENCE -STATE
<br />Nebraska
<br />9b.000NTY
<br />Hall
<br />sit. STREETANDNUMBER
<br />305 Wainwright J
<br />18e. MARITAL STATUS AT TIME OF DEATH ® Married ❑ Never Married
<br />0 Married, buteeparated 0 Widowed 0 Divorced ❑ Unknown
<br />1t FATHER'S -NAME (First;`: Middle, Last, Suffix)
<br />Earl Gene Wilson'
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unk.l No
<br />3: METHOD OF DISPOSITION
<br />Q Burial Q Donation
<br />,ablation Q Enttmtbment
<br />❑ Removal 0 Otinr (Specify)
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Female
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />HOURS
<br />MINS.
<br />3. DATE OF DEATH' III
<br />May 1, 202E .;.
<br />pay
<br />8. DATE OF BIRTH (Mo., Day, Yr.)
<br />January 1, 1
<br />se. PLACE OF DEATH
<br />HOSPITAL Q Inpatient , OTHER 0 Nursing Home/LTC
<br />❑ ER/Outpatient ® Decedent's Home
<br />❑„ DOA ❑ Other (specify)
<br />8d. COUNTY OPDEATH
<br />Hall
<br />9c. CITY OR TOWN
<br />Grand Island
<br />9s. APT. NO.
<br />W. ZIP CODE
<br />68801
<br />948.
<br />[ .Tloeplw Faalgty
<br />9g, HISIL' E CITY LIARS
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, Ova maiden name
<br />Micheal Voss
<br />14a. INFORMANT -NAME
<br />Micheal Voss
<br />18a. FUNERAL DIRECTOR SIGNATURE
<br />Katie M. Smydra
<br />1Z MOTHER'S -NAME (First, Middle, Maiden Sumatra)
<br />Viola Sorensen
<br />18d. CEMETERY, CREMATORY OR OTHERLOCATION
<br />Central Nebraska Cremation Services
<br />1Ta FUNERAL 11091E NAML;AND MAILING ADDRESS (Street, City or Town, State)
<br />Ada aiths Funeral Herne, 2929 S. Locust Street, Grand Island, Nebraska
<br />Tab. LICENSE NO.
<br />1454
<br />CITY 1 TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and ixamDles)
<br />1e. PART I. Hex the chain of events -.diseases, alludes, or complicationsthat directly caused the death. DO NOT enter teminal *vents such as cardiac arrest,
<br />-----..-`latabrNNtlatialth lashowingaaetiology.DONOTAIIR6W1T@,Enmirsalon Tim on"NM.Add additional llme netesssiy.
<br />ada0.rD1a71)I1rkM1
<br />nNewl ttrCWldllpli:resexln9
<br />In death)
<br />equentiWy Net conditlons, t
<br />any, NWing ht1M saute hated
<br />on Nnre a.
<br />Enter BN UN DERVYINO CAUSE
<br />(disease or injury that Initiated
<br />lire events resulting 1miNth)
<br />;NABT .
<br />IMMEDIATE CAUSE:
<br />a) colon cancer
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b) 7
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />DUE TO, `OR AS A CONSEQUENCE OF:
<br />d)
<br />18. PART It OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the deelhrbut not resulting In the underlying cause given in PART 1.
<br />Atrial Fibrillatlert Gastrointestinal hern6rrhage
<br />2(L IFfMALE:
<br />pragnanlwiddnpsetyierlr:
<br />Pngnantatimlddeath :
<br />❑ Not plagued, but pregnant within 42 days or death
<br />❑ Not pregnant, but pregnant 43 days to 1 year baron Math
<br />❑ Unknewn'tprepnent wtthtnire out year
<br />22o. PATE OF INJtiity,( Mo Day, Yr.)
<br />22d. INJURY AT WORK?
<br />QYESS CletO
<br />21a. MANNER OF DEATH
<br />gl Natural ❑ H`7ulclile
<br />❑ Accident ❑ Pending Investigation
<br />❑ suit
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />orivet10per.tor
<br />❑ Pesaengsr
<br />El Pedestrian
<br />El«her(spacxyl
<br />14b. RELATIONSHIP TO DECEDENT
<br />Spouse
<br />180.DATE (MO,Oat,yr)
<br />May 4/ 2028
<br />STATE
<br />..Nebraska
<br />1 }Tlk firs 000.1
<br />68801
<br />onset td death
<br />onset to drffiffi
<br />onset t i $heal,
<br />19. WAS MEDICO, earkr INER4 `'
<br />OR CORONER CONTACTED?
<br />❑ YES ..® NO
<br />y14c. WAS AN AUTOPSY PERFORMEDT
<br />❑ YES ®NO
<br />Ede El Could not be determined 21d. WERE AUTOPSY FINDINGS AVAILABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES ❑ NO
<br />22c, PLACE OF INJURY -At horns,farm, street, factory, office building, won'.tt ($pPCiljr)
<br />22s. DESCRIBE HOW INJURY OCCURRED
<br />2. LOCATION OF:INJURY -STREET & NUMBER, APT.NO. CITY/TOWN
<br />STATE
<br />II
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />May 1 2026
<br />/
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />Mav 3, 2026
<br />23c. TIME OF DEATH
<br />11:56 PM
<br />!7d To tr Wet efal>f.k1Yo Medpe, Math occurred at the time, date and place
<br />end tlw to th. tiuee(s) shard. (Signtahee and Tim)
<br />Gary L Settle, MD
<br />2li DID TOBACCO USE CONTRIBUTE TO THE DEATH?
<br />YES g'NO [;PROBABLY 0 UNKNOWN
<br />N ME, TITLEAND ADDRESS OF CERTIFIER (Type or Print
<br />Gary L Settje, MD, 416 N Diers Ave, Grand Island, Nebraska, 68803
<br />Ma. REGISTRAR SSIGNATUREO�� 8) _
<br />24a. DATE SIGNED (Mo., Day, Yr,)
<br />24c: PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />244d. TINE PRONOUNCED # EACr
<br />toe. On ilea bwia of examination andror imestigNlen, N my opbniee death MAHA d at
<br />the NMI, date and place and due to the cowls) stated. (signature and TIN)
<br />28a. HAS ORGAN OR TISSU DONATION BEEN CONSIDERED?
<br />❑ YES Ea NO
<br />28b. was CONSENT ORANTED?
<br />Not Applicable N 26a Is NO
<br />tab. DATE FILED BY REGISTRAR (Mo., Day, Yr.)
<br />May 8, 2026
<br />
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