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<br />STATE OF NEBRASKA
<br />Mr!!!/rrrrrnllll. a //GII'IIIIFIFI11\a eiryriri4lddi //441'IIIFfIIPIwa �. nrrrhnln
<br />il!f4 ilyr,l 'its `�liil n,!(//ir,av\Nl.i :�±ltlilii�!�/, ,ur44L�1)I)r .� {,{tH1:li.`.NI
<br />WHEN Tits COPY;CARR. ES 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 />LATE OF 1$SUANDE
<br />4/17/2026
<br />UNCOLN,: NEBRASKA
<br />2026044'10
<br />:56> t."
<br />841.101
<br />SARAH BOHNENKAMP
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />/STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />1 CeoitiT'8.14iAME (FIrst. Middle, Last, Suffix)
<br />Janes Arthur Ovens*
<br />CERTIFICATE OF DEATH
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Chicago Illino)s
<br />. SoetAF:SECURITY.NUMBER
<br />356 50 1639
<br />5a. AGE - Last Birthday
<br />(Yrs.)
<br />69
<br />8b. FACIUTY-NAME (If not Institution, give street and number)
<br />Chll'Health.;t. Francis
<br />1c. C(YV oft Town OP DEATH (Include Zip code
<br />)
<br />Grand Island 68803
<br />ga. RESIDENCE -STATE
<br />tM. STREETAND NUMBER
<br />1118 W10111 Street
<br />9b. COUNTY
<br />Hall
<br />10 . MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married
<br />Q Monied, but. separated •..❑ Widowed 0 Dlvoreld ❑ Unknown
<br />11 FATHER'S NAME (First, ! Middle, Last, Suffix)
<br />Andrew John Gyenes
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unit.) NO
<br />1.5. *OH. 00:OFDISPOSIT10N
<br />❑ ;Burtat ❑ DwnatTof
<br />® {.renlaMon:: ❑ Erlttinibment
<br />❑ Removal 0 Other (Specify)
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8•. PLACE OP DEATH
<br />HOSPITAL El Inpatient
<br />❑ Eft/Outpatient
<br />DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />3. DATE OF DEATF((Mii.,
<br />March 29, 2026
<br />9f, Yt•
<br />8. DATE OF BSTTH (Mo., Day, Yr.)
<br />August 26, 1
<br />/'
<br />OTHER ❑ Nursing Home/LTC
<br />❑ Decedent's Hone
<br />❑ Other (specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />be. APT. NO.
<br />9f. ZIP CODE
<br />68801
<br />9
<br />N IM 8 PM/ UM'ITS
<br />YE$
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) if wife, give maiden name
<br />Karla Ra e Ry
<br />savy
<br />1 12. MOTHER'S -NAME (First, Middle, Maiden Surname)
<br />Lorraine Sunde
<br />14a. INFORMANT -NAME
<br />Karla Raye Gyenes
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Laurie\D. Sheffield
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />14.1 INERALHOME NAME .AND MAIUNG ADDRESS (Street, City or Town, State)
<br />All Fasts Funeral Home, 2929 S. Locust Street, Grand Island, Nebraska.
<br />16b. UCENSE NO\
<br />1397
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examples)
<br />ta. PART I. Enter the enslave events- douses, injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />re.{pItBIRO artfll,or vS trkular tibrINation without showingf be etiology. DO NOT ABBREVIATE. Enter only one -cads@ on a ono. Add additional lines if necessary.
<br />IMMEDIATE CAUSE:
<br />UEitEDIAT1t CAUSO:jpinal ::
<br />diseaN ieilnditkifiniwpag
<br />In death)
<br />eegliendai tr Nat condwen:. B
<br />tiny Mwdligltater awekww
<br />ten h..
<br />Enter Br UNDERLYING CAUSE
<br />(dimes or Injury that initiated
<br />the events resulting In death)
<br />FAST
<br />a) intestinal ischemia
<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. PAFtTlL OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting in the underlying cause given In PART I.
<br />38 IF FEMA1 E
<br />Nat pMgnaMam011nparty ea
<br />❑ Rlogtwntatt nq o/dMER'
<br />❑ Not pregnant, but pregnant within 42 days of death
<br />Not plPgnarit, but enw.omnt 43 da s to 1 year before death
<br />❑ unknown lf prr.(Pumt wlthhl n past yew
<br />32a. DATE OF INJURY :FM ?Day, Yr.)
<br />22d. INJURY AT WORK?
<br />0Y.ES ONO
<br />2.2f.1IZ/CATION'
<br />'INJ
<br />21 a. MANNER OF DEATH
<br />® Natural ❑ Homicide
<br />❑ Accident 0 Pending investigation
<br />❑ Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />❑ DAverlop.rator
<br />❑ Passenger
<br />❑ Pedestrian
<br />❑ Other (Specify)
<br />14b. RELATIONSHIP TO DECEDEI'j
<br />16c. DATE (Mt Oa
<br />March 31,2028
<br />STATE
<br />onset to death
<br />onset to tNath
<br />19. WAS MEDICAL>EXAMINER"'
<br />OR CORONER CONTACTED?
<br />❑ YES ..::.®:NO
<br />21e. WAS AN AUTOPSY PERFORMED?
<br />❑ YES OLI No
<br />21d. WERE AUTOPSY FINDINGS AVAU.ABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES Q Mil
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction GI.
<br />22s. DESCRIBE HOW INJURY OCCURRED
<br />STREET 2. NUMBER, APT.NO.
<br />CITY/TOWN
<br />STATE
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />March 29 2026
<br />22b DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH
<br />April 14 2026 05:25 PMy 04 To Ow boat °To'time,
<br />'knowledge, death occurred at the te, date and place
<br />and due to Ow ousels) stated pignature and TNIs)
<br />Travis S. Hageman, MD
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />24f1. TIME PRONOUNCED.
<br />24a. on the basis of examination and/or investigation, In my Opinionogee tic(iYiired at -: ..
<br />the time, date and place and due to the cause(s) stated (Siglutwa end Me),
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑YES 17l NO
<br />28 Q:TOBACCOiuse .CONTRIBUTE TO THE DEATH?
<br />YES NO ❑'PROBABLY ® UNKNOWN
<br />27. NAME,.11TLEAND- ADDRESS OF CERTIFIER (Type or Print
<br />Travis S. Hageman, MD, 729 North Custer Avenue, Grajld Island, Nebraska, 68803
<br />ltbe REGISTRAR'S SIGNATURE
<br />4Ji �s /r r n rrL yy
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable if 26a is NO 0 YES tj P40
<br />28b. DATE FILED BY REGISTRAR[MO„:DAy, Yt).:;::
<br />April 14, 2026
<br />
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