|
rl )i•'" )i(iiipisriur.�a,i,,, 11,N.LiI,llli)sss.;oa,
<br />STATE OF NEBRASKA
<br />42t459'lard.'1CDJFgc>:;:.;'°'•�r,AhM�1. J�u• �:�
<br />tIS COPYCARRIES THE RAISED SEAL OF STATE OF NEBRASKA,:IT CERTIFIES THE DOCUMENT BELOW TO
<br />A TRUE COPY OP me 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 />t.V ����Q11l1l1lII►11j'
<br />D4IE F ISSRt I S[irB;;;
<br />3131 /2028
<br />RASKA
<br />2026_04164
<br />444
<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;C CEf Eir$-NAME ►►t, Middle, Last, Suffix)
<br />Arnold:Charlea°';.:Prorock Jr
<br />4, CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grant! Island, Nebraska
<br />7_;EOCIA:. SECURITY NtJIiR:;;
<br />5a. AGE - Last Birthday
<br />(Yrs.)
<br />15 Ob. FACIUTY-NAME (If not Institution, I vs street and number)
<br />:: .Ht health St«Fratacas.HMS
<br />:CIT(OR TOWN OF iEATh (Mai
<br />>Grand' sl (nd 6880
<br />RESIDENCE -STATE
<br />.Nebraska
<br />ad::STREET AND NUMBER
<br />Zip Code)
<br />9b. COUNTY
<br />Hall
<br /><1515:Sppruce Plat ''<
<br />10.. MARITAL STATUS AT T11ME OF DEATH ba Married ❑ Never Married
<br />0 Married, but separated ❑ Widowed ❑ Divorced ❑ Unknown
<br />11 FAT4EF S-NAME (Firs!, > `'Nbddi., Last, Suffix)
<br />+(kmold F1al it? s <Ptortick . Sr
<br />1x EVEI IN U.S. ARMED
<br />F (Vas, No, Or Unk.) No
<br />d5.stemo+:OFDIlit+OSI >
<br />O.Burisl:.'>:;: ❑`DAttttiGik:::::
<br />::: Entwnbmsnt
<br />0 Removal ❑!their (Specify)
<br />75
<br />5b.UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />6c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE:O:F DEATH
<br />HOSPITAL Ii Inpatient
<br />❑ ERiOutpatlent
<br />❑ DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />3. DATE OF
<br />March 14,
<br />8. DATE OF MOO..
<br />May 6,
<br />OTHER ❑ Nursing Horns/LTC
<br />❑ Decedent's Hem,
<br />❑ Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />)e. APT. NO.
<br />9f. ZIP CODE
<br />68801
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wits, give lesiden none'
<br />Vicki Defines
<br />12, MOTHER'S -NAME (First,
<br />Dorothy . •:•Krakowski
<br />14a. INFORMANT -NAME
<br />Vicki Prorpck _ /
<br />18a. FUNERAL DIRECTOR SIGNATURE
<br />Daniel D Naranjo
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />FUNERAL HOME -NAME AND MA LING ADDRESS (Street, City or Town, State)
<br />Faiths FuneralHorne, 2929 S. Locust Street, Grand Island, Nebraska
<br />1a. PA*TL
<br />NE0411:%'tI. DAl ts# (Itillf
<br />i.YeMf'idI: C011tlilb0tt IYIUltlfl$
<br />11b LICENSE NO.
<br />1071
<br />Middle, Maiden Surname)
<br />14b. RELA'id
<br />Spouse
<br />lea DA1R(I
<br />March 17; 2
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examples)
<br />arnierofevtMa. ab.as.s, W)<Irles, or complicanons4hat directly caused the death. DO NOT enter remains avant such as cardiac anest,
<br />or vantticular ttbttliMion without showing the etiology. DO NOT ABBREVIATE. Enter only on. cause on a line. Add additional linos if necessary.
<br />IMMEDIATE CAUSE:
<br />t iAnoxic brain injury
<br />DUE TO, OR AS A'CONSEQUENCE OF:
<br />14cardiac arrest
<br />TO, OR AS A CONSEQUENCE OF:
<br />acute respiratory failure
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d1
<br />1S <PARTE : OTHER MIONHIC.ANT CONDITIONS-Condltions contributing to the death but not resulting in the Underlying cause given in P
<br />diaphragmatic paralysis;' sleep apnea, hypertension, hyperlipidemia, peripheral neuropathy, prediabetes
<br />,-y Not,prsgn.r4 within
<br />ProOiaM t:N ii M.5aa'9i': :!::
<br />' 0 Nat prsgttadt, but within 42 days o►daaM
<br />❑ Nat Pwo • but p 43 day. to i gar !Mars death
<br />:.Q; .4 nknawn I prinerniE a is tlw ptM year /
<br />; AlEt)FItI 11JRY' Mtli i y. Yr.) 22b. TIME OF INJURY
<br />22d. INJURY ATWORK'P
<br />,I CCIM"FiON;L)F EI9JUPrl;r8?RHET iNUMBER, APT.NO.
<br />23a. DATE OF DEATH (Ms., Day, Yr.)
<br />Mardi 14, 2026
<br />23b DATE:SIGNEDIMc., Day Yr.)
<br />March 24 2026
<br />21a. MANNER OF DEATH
<br />RI Natural El Homicide
<br />CI Accident El Pending tnveatigatbn
<br />❑ Suicide El Could not be determined
<br />21b. IF TRANSPORTATION INJURY
<br />Q DNwr/Operator
<br />' A.1 Passenger
<br />ElPedeMrian
<br />❑ Other (Specify)
<br />ART L 19. WAS
<br />ORC
<br />❑ YE
<br />21 c. WAS AN AUT
<br />❑ YEs
<br />21d. WERE A
<br />TO COMP
<br />❑ YES
<br />22c. PLACE OP INJURY•At home,1aim, strait,: factory, office building, construction.
<br />22s. DESCRIBE HOW INJURY OCCURRED
<br />CITY/TOWN
<br />23c. TIME OF DEATH
<br />10:00 PM
<br />:ad. Te thud bolt of my;fcnowte lge, death eecurrs4 at the time, date and place
<br />`..:Ind 44144064 clumt(e) stated. ovation and Title)
<br />Jay C. Anderson, MO
<br />6. DIO TOBACCO USE TO THE DEATH?
<br />VES itii NC PROBABLY 0 UNKNOWN
<br />OF CERTIRER (Type or Print
<br />D, 729 North Custer'Avenue, Grand Island, Nebraska, 68803
<br />C
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. ruse OM DEATN,,
<br />24d. TIME
<br />24e. Oh 1ha born of examination and/or inwsdgation, in my 0pi4is0
<br />8w1 time, date and place and due to the caisson') stated. (6iggeawa
<br />26a. HAS ORGAN OR TI UE DONATION BEEN CONSIDERED?
<br />❑YES 10 NO ...
<br />26b. WAS CONSENTsGRA
<br />Not Applicable If 264 Is NO
<br />28b. DATE FILED BY RE
<br />March 24, 2026
<br />
|