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<br />WHEN TIIIS COPY CARRIES THE RA/SLID SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BE A TRUE COPY' OF 7' lE ORIGINAL RECOftD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFI(E, WHICH IS THE LEGAL DEPOSITORY -FOR VITAL RECORDS
<br />a
<br />8
<br />.I'
<br />04TE OF ISSUANCE
<br />5/19/2026
<br />LINCOLN, NEBRASKA
<br />202603786
<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 DECEDENTS -NAME (First Middle, Last, Suffix)
<br />Randall 4 0e solos
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand Island, Nebraska
<br />9001AL SEcue►TY MINDER
<br />506 60.6953
<br />ea. AGE Last Birthday
<br />(Yrs.)
<br />76
<br />eb. FACILITY -NAME (If not Institution, give street and number)
<br />CFI[ Health St. Francis
<br />Sc. CITY OR TOWN OP DEATH (Include Zip Code)
<br />Grand Island 68803
<br />ea. RESIDENCE -STATE
<br />Nel"uaske
<br />ed STREET AND NUMBER
<br />1031 North Howard
<br />Ob. COUNTY
<br />Hall
<br />10a. MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married
<br />Q Married, byg seParOtad 0 Widowed 0 Divorced ❑ Unknown
<br />11. FATHER'S-NA/WE (First,
<br />Dale Spiehs
<br />Middle, Last, Suffix)
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unk.) No
<br />1b. METHODOF DISPOSITION
<br />B1uria1 ❑ Donation
<br />Q CnMuttion [ Entomlunent
<br />0 Removal ❑ Other (SMGN)
<br />6b. UNDER 1 YEAR
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL Igj Inpatient
<br />❑ ER/Outpadent
<br />❑ DOA
<br />8c. CITY OR TOWN
<br />Grand Island
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MINS.
<br />HOURS
<br />26 05979
<br />3. DATE OF DEATH:(Nlq Day, Yr 3 <
<br />April 28, 2026:
<br />6. DATE OF BIRTH (Mo., Day, Yr.)
<br />June 30t 1949
<br />OTHER 0 Nursing Home/LTC
<br />❑ Decedent's Home
<br />❑ Othw (Specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />Its. APT. NO.
<br />W. ZIP CODE
<br />68803
<br />❑ #&despiteFacility
<br />al/ANODE CITY utnra''
<br />:Tea 13
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) grille, give maiden name
<br />Lynn Campbell
<br />14a. INFORMANT -NAME
<br />Lynn Spiehs
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Daniel D Naranjo
<br />16d. CEMETERY, CREMI4TORY OR OTHER LOCATION
<br />Grand Island City Cemetery
<br />1741. FUNERAL HOME NAME AND MAIUNG ADDRESS (Street, City or Town, Stab)
<br />All Faiths Funeral Horne, 2929 S. Locust Street, Grand Island, Nebraska
<br />12. MOTHER'S -NAME (First, Middle, Maiden Summons)
<br />Twila Geiser
<br />16b. UCENSE NO.
<br />1071
<br />CITY /TOWN
<br />Grand Island
<br />CAUSE OF DEATH (See Instructions and examples)
<br />111. PART 1 Lntar the chain of events- diseases, Injuries, or complIcaaomMat directly caused the Math. DO NOT enter terminal events such as cardiac arrest,
<br />napiritaty mut, or vi*Ic tar fibrillation vdtout showing the etiology. DO NOT ABBREVIATE. Easter only one cause on a line, Add additional lines if necessary.
<br />IMMEDIATE CAUSE:
<br />a) Cardiorespiratory Failure
<br />eaaleg titTE cAUtiBtnat
<br />tlhPase6r p{uldltlilly:te�uhldp :`
<br />In death)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />arpuentieblist canal/omit ..:.. b)
<br />ley, lartanStothe r*usefisted
<br />1100
<br />DUE TO. OR AS A CONS 9UENCE OF:
<br />Seta the UNDERLYING CAUSE c)
<br />Menem or injury that Initiated
<br />the *vents resulting In death)
<br />100IT
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />1e. PART tie CTHtRLSIGNIFf.ANT CONDITIONS -Conditions contributing to the death but not resulting In the underlying cause glean In PART 1.
<br />Adenocarcinoma of the lung with metastasis to the braih, liver and bones , Pathologic Fracture of the proximal radius neck with
<br />metastatic bone disease, Failure to thrive in adult, Pancytopenia, Atrial Fibrillation, Pulmonary Embolism, Acut
<br />20. IF FEMALE:
<br />NQ1limonont, Pon peat ye t :
<br />Pyrgnam at tlm.(et daedn
<br />❑ Not pregeaat, but pregnant within 42 days of death
<br />❑ Not pregnant, but presnent 43 days to 1 year before death
<br />❑•
<br />Ulil oorm d pmEnrd wlednllN past yew
<br />22a. DATE OF INJURY 4Mo., Gay, Yr.)
<br />22e. INJURY AT WORK?
<br />YES ❑NO
<br />21a. MANNER OF DEATH
<br />RI Natural ❑ Homicide
<br />❑ Accident 0 Pending Monetiaetlon
<br />❑ Suicide 0 Could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />❑ Ddwr/Opetator
<br />❑ Passenger
<br />❑ Pedestrian
<br />❑ Other (Specify)
<br />14b. RELATIONSHIP TO OECEI*NT
<br />Spouse
<br />16c. DATE (Moq D■yx Sul'.):;
<br />May 5, 2026
<br />STATE
<br />APPROXIMATESI'fERV U.
<br />onset ts death.;;:
<br />Minutes
<br />onsettod.Mh
<br />onset todtls#i`
<br />19. WAS MEDICAL ALSAMINESt.'
<br />OR CORONER CONTACTED?
<br />® YES ..:.❑ No.
<br />21c. WAS AN AUTOPSY
<br />0 YES ® NO;:
<br />21d. WERE AUTOPSYPINOINGS AVMLAB.E
<br />TO COMPLETE CAI✓ E QF Dr'ATHI ---
<br />YES ❑ 4o
<br />22e. PLACE OF INJURY -At home, farm, street, factory, ofca building, construction sits, etc. (Spselfy)
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />2N. LOCATION OF'(NJURY »STREET& NUMBER, APT.NO. CITY/TOWN
<br />•
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />April 28, 2026 1
<br />23b, OATE SIGNED (Mo.. Day. Yr.)
<br />Mat, 4. 2026
<br />23c. TIME OF DEATH
<br />05:06 AM
<br />22d. to dta twit orfpy9novdedge, death occurred at the time, date and place
<br />"and {NOW the tiiluse(a) stated. (Signature and Title)
<br />Venkata S Kanakadandi, MD
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.) '
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />CODE
<br />24b. T1ME OF DEATH
<br />2h. TIME PRONOUNCED:DEAD:
<br />24s. On th►--basis of examination and/or investigation, in my opinion dN
<br />the time, date and place and due to the count') stated. (SISOaoaa
<br />IND:TOBACCO t$ECON'YRIBUTE TO THE DEATH?
<br />ja YES al NO DDR PROBABLY ❑ UNKNOWN
<br />'/• NAME', TITLE AND A ESS OF CERTIFIER (Typo or Print
<br />Venkata S Kanakadandi, MD, 2620 W Faidley Ave, Grand Island, Nebraska,68803
<br />i
<br />26a. HAS ORGAN OR TISSUE DO TION BEEN CONSIDERED?
<br />0 YES g •
<br />26b. WAS CONSENT GRANTEDT::
<br />Not Applicable if 26a Is NO 0 3
<br />28b. DATE FILED BY REGISTRAR jute., Dt, Yr.};?'::
<br />May 6, 2026
<br />
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