|
,euwooP(ata
<br />�'11/ILI'i��(rr60�QONNoi/yY(rZi:1 1i1MIDo i trr�tili(►►tmok
<br />STATE OF NEBRASKA
<br />miil(IrrtNatt x < ttiSrfaa�v
<br />�4,�ciilYllgaaa�r,
<br />NNW 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 />1
<br />1�>
<br />1
<br />�o
<br />i
<br />D4TE OF ISSUANCE
<br />5/26/2026
<br />LINCOLN, NEBRA$KA
<br />202603960
<br />80,44tAnk4
<br />SARAH BOHNENKAMP r
<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. bECEDENDS-NAME (First, Middle, Last, Suffix)
<br />John William Stitt
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Hastings, Nebraska
<br />7. SOCIAL SECURITY NUMBER
<br />510-484781
<br />5a. AGE - Last Birthday
<br />(Yrs.)
<br />77
<br />8b. FACILITY -NAME (If not Insdrirtlon, give street and number)
<br />the Oaks at Central :Cite
<br />tic. CITY OR TOWN OF DEATH (Include Zip Code)
<br />Central City 68826
<br />9a. RESIDENCE -STATE
<br />Nebraska
<br />9d. STREET AND NUMBER
<br />12450 W Highway. 30.
<br />9b. COUNTY
<br />Hall
<br />10a. MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married
<br />❑ Married, but separated 0 Widowed [3Divorced 0 Unknown
<br />11. FATHEWS•NAME (First,:::: Middle, Last, ', Suffix)
<br />Detlar Stitt
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unk.) t�0
<br />15: METHOD OF DIS ITION
<br />❑ ocelot I Donation:
<br />® Cremation 0 Entombment
<br />Removal ❑ Other (Specify)
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />bt. UNDE 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL ❑'inpatient
<br />❑ ER/Outpatient
<br />❑DOA
<br />9c. CITY OR TOWN
<br />Wood River
<br />HOURS
<br />MINS.
<br />26 05766.
<br />3. DATE OF D THtNo., Day Yr.)
<br />April 27, 2026
<br />6. DATE OF BIRTH (Mo., Day, Yr.)
<br />January 22 1945..
<br />OTHER ® Nursing Home/LTC Cliffitiffict Fa01Ety
<br />❑ Decedents Home
<br />❑ Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Merrick
<br />Ye, APT. NO.
<br />9f. ZIP CODE
<br />- 68883
<br />9g 1NE1oE Cr(Y LSETsk
<br />YEs i1d
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name
<br />Robin Hofrichter
<br />14a. INFORMANT -NAME
<br />Robin Stitt
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Baylee Jolene Clifton
<br />12. MOTHER'S -NAME (First, Middle, Malden Surname)
<br />Laura Rath
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />1711. FUNERAL HOME NAME AND MAIUNG ADDRESS (Street, City or Town, State)
<br />Apfel Funeral Home. 1123 W. 2nd, Grand Island, Nebraska
<br />18b. LICENSE NO.
<br />1604
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examples)
<br />18. PART 1. Enter the chain of events- -diseases, InJuriss, or complleadons.that directly cauud the death. 00 NOT enter terminal events such as cardiac artist,
<br />,., resphatory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter obey one ;auto on a line. Add additional lines E necessary.
<br />IMMEDIATE CAUSE:
<br />IMMEMATECAU5sMast r-a)Alzheimers
<br />digest* Or condNI n
<br />In death)
<br />seauentt sly list conditions, it ..
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b) Hypertension
<br />any. Wading to the uses.• Mod
<br />Enter t s UNDERLYING CAUSE
<br />(cheese or injury that initiated
<br />tin events resulting In death)
<br />LABT;<•
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />c) Diabetes Type 2
<br />NN
<br />DUE TO, OR AS A CONSEQUENCE OF
<br />d)
<br />18. PART it. OTHER\SIGNIpiCANT CONDITIONS -Conditions contributingio the death but not resulting In the underlying cause given In PART I.
<br />2L IF FEMALE:
<br />❑ Net prypllmt w)AIUa tam yoer
<br />❑ Pgg list at time or Mash
<br />❑-Nat Prei s1s,L tea pregnant within 42 days of loth
<br />:..❑ Nat pregnant, but pregnant 43 days to 1 year before deem
<br />❑ ttflmewn 6 PRISOI ntldtM the Psit yet
<br />222a. DATE OF-1
<br />RY into,;
<br />y, Yr.)
<br />21a. MANNER OF DEATH
<br />Natural ❑ Homicide
<br />0 Accident 0 Pending Investigation
<br />❑ Suicide 0 Could not be detemOned
<br />22b. TIME OF INJURY
<br />21b, IF TRANSPORTATION INJURY
<br />0 odver/Operator
<br />❑ Passenger
<br />0 Pedestrian
<br />❑ Other (Specify)
<br />14b. RELATIONSHIP TO DECEDENT
<br />Spouse
<br />16c. DATE (Mo,Day,.Yr.)
<br />April 29, 2026
<br />/ ,
<br />STATE
<br />Nebraska
<br />lift,zipod.
<br />68601
<br />APPROXIMATE INTERVAL
<br />oraettodum:
<br />5 Years
<br />onset to d4lath
<br />5 Years
<br />outset to death
<br />5 Years.... '
<br />onset to.h ..
<br />19. WAS MEDIOALEXAMINER C
<br />OR CORONER CONTACTED?
<br />❑ YES ® NO
<br />21c. WAS AN AUTOPSY PERFORMED?
<br />❑ vas Ea i o
<br />21d. WERE AUTOPSY FINDINGS AVAILABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES ❑ NO
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction sins, etc Sp4effy)
<br />22d. INJURY AT WORK?
<br />[OYES ONO
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />22f. LOCATION OF INJURY : STREET & NUMBER, APT.NO.
<br />CITY/TOWN
<br />STATE
<br />234. DATE OF DEATH (Mo., Day, Yr.)
<br />April 27, 2026
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />Aori1.30..2026
<br />23c. TIME OF DEATH
<br />09:30 PM \
<br />tad To1ae boat of my know..dgs, death occurred at the the, ate and place
<br />and due to the Camels) stated. (Signature and Tula)
<br />Thomas L Vonderfecht, MD
<br />2Aa. DATE SIGNED (Rio., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Daly, Yr.)
<br />24b. TIME OF DEATH
<br />24d. TIME PRONOUNCED:#1EAD
<br />24e.On t s basis of examination and/or investigation, In my opinion death litigious at
<br />the the, date and place and dui to the cause(s) stated. (Signature and Tieb) ......
<br />25. DID tosAcco use COI+ITRIBUTE TO THE DEATH? 28a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />YES NO 0.PROBABLY 0 UNKNOWN ❑ YES 7 +
<br />27. NE; i7LE AHD bBitess OF CERTIFIER (Type or Print
<br />Thomas L Vonderfecht, MD, 3563 Prairieview St Ste 300, Grand Island, - raska, 68803
<br />26e. REGISTRAR'S SIGNATURE
<br />Dr✓la_.i► 8 L ?
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable If 26a is NO DYES ❑ NO
<br />28b. DATE FILED BY REGISTRAR(Mo., Day, Y►) ..
<br />May 1, 2026
<br />
|