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STATE OF NEBRASKA
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<br />OWN IS COPY:CARRI'IS THE RAISED SEAL OF STATE OF NEBRASKA, It' CERTIFIES THE -DOCUMENT BELOW TO
<br />BE ATRUE 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 />DATE.IS$t/41010
<br />5/26/2026
<br />LINCOLN, NEBRASKA
<br />,_5104
<br />&Amick
<br />SARAH BOHNENKAMP j
<br />2 02 60 4 5 8 4 ASSISTANT RAR
<br />DEYAR MENT OF HEALTH
<br />AND HUMAN SERVICES
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERTIFICATE OF DEATH
<br />141ECEDENT&NAME (First Middle, Last, Suffix)
<br />Robert Lee' Btuei. :
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand Island Nebraska •
<br />" SOCIAL SECURITYNUMBER
<br />5O7-96.9887
<br />5a. AGE - Last Birthday
<br />(Yrs.)
<br />8b. FACIUTY-NAME (N not Institution, give street and number)
<br />1022 E Oklahoma Avenue
<br />8c. CITY OR TOWN OP DEATH (Include Zip Code)
<br />Grand island 68803
<br />9a. RESIDENCE -STATE
<br />;Nebraska
<br />9d. STREETAND NUMBER : •
<br />1022 E Oklahoma Avenue
<br />9b. COUNTY
<br />Hall
<br />10a. MARITAL STATUS AT TIME OF DEATH ® Married ❑ Never Married
<br />0 Married, but separated ❑ Widowed 0 Divorced 0 Unknown
<br />11 FATHER'S -NAME (First,.•. Middle, Lest, Suffix)
<br />Ronald Lei . Blue >`'
<br />49. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unk.) Yes
<br />15 METHOD OF DISPOSITION
<br />® Burial Q Donetion`
<br />❑ Cremation.❑ Entombment
<br />❑ Removal ❑ Other (Specify)
<br />62
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />HOURS
<br />MINS.
<br />26 t3702 ;
<br />3. DATE OF DEATkt (004 Diay Yr) E;
<br />May 13, 2026
<br />8. DATE OF BIRTH (Mo., Day, Yr.)
<br />October 21,
<br />8a. PLACE OF DEATH.
<br />HOSPITAL ❑ inpatient OTHER ❑ Nuraing Home/LTC
<br />m ❑ ER/Outpatient r_ El Decedent's Ha
<br />❑:DOA ❑ Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />9c. CITY OR TOWN
<br />Grand Island
<br />IN. APT. NO.
<br />9f. ZIP CODE
<br />68803
<br />;1963.
<br />f(i7sp100-Fa01140
<br />10b. NAME OF SPOUSE (First, Middle, Laid Suffix) If wife, give maiden name
<br />Keith Keeler
<br />14a. INFORMANT -NAME
<br />Keith Keeler
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Gwen K. Hyronemus
<br />12. MOTHER'S -NAME (First, Middle, Maiden Surname)
<br />Ruby Mao Eickhoff
<br />IN}, LICENSE NO.
<br />1448
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION CITY / TOWN
<br />Nebraska Veterans Memorial Cemetery Grand Island
<br />17a. FUNERAL HOME NAMEE;AND MAILING ADDRESS (Street, City or Town, State)
<br />Apfel Funeral Home,1123 W. 2nd, Grand Island, Nebraska
<br />CAUSE OF DEATH (See instructions and examples)
<br />111. PART I. Enter the chain or events- diseases, injuries, or complications -that directly causedthe death. DO NOT enter temtinal events such as cardiac arrest,
<br />respiratory crest, or vamrlcuiartlbnilatlon without showing the etiology. DO NOT ABBREVIATE. Enter only one mum on a One. Add additional lines 8 necessary.
<br />IMMEDIATE CAUSE:
<br />IMMEDIATE CAUSE Moat : a) metastatic non small cell lung cancer
<br />diseast er condition resulting'`
<br />14b. RELA i(
<br />Husband
<br />DENT
<br />18c. DATE (Mo., Day, Yr) .,
<br />May 1972020
<br />.ATE
<br />Nebraska
<br />APPROXIMATM INTERVAL
<br />death)In DUE TO, OR AS A CONSEQUENCE OF:
<br />d..quentknly Eat condition, E b)
<br />eny, Wading to ine:aluse Salad:
<br />on I•ota a •
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />Enter the UNDERLYING CAUSE C)
<br />(disease or injury that initiated
<br />the events resulting In death)
<br />EAST•
<br />•
<br />16. PART H OTHER SIGNIFICANT CONDITIONS-ConditIons contributing to the heath but not resulting in the underlying cause given in PART 1.
<br />Chronic Kidney Disease Stage 4, chronic hepatitis c, Chronic atrial fibrillation
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />200F.FEMALE .:
<br />O Not pregn)8 t¢kMn past yur
<br />❑ PRigdantattlfsabf eaSs; 7
<br />0 Not premier*, but pregnant within 42 days of death
<br />0 Not pregnant, but pregnant 43 days to 1 year before death
<br />.
<br />•
<br />© Unknovm lt prcgnewlth a ldilte past year•
<br />•
<br />22a. GATE
<br />INJURY (Moy:::Day, Yr.)
<br />22d. INJURY AT WORK?
<br />OYES QNO
<br />21a. MANNER OF DEATH
<br />® Natural m Homicide
<br />0 Accident 0 Pending Investigation
<br />0 Suicide ❑ Could not be dltermined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />❑ Driver/operator
<br />❑ Passenger
<br />0 PaWshlan
<br />0 Other (Specify)
<br />onset to death
<br />19. WAS MEDICAL EXAMINE*.
<br />OR CORONER CONTACTED?
<br />❑ YES &J NO
<br />21c. WAS AN AUTOPSY AER00100,07:
<br />❑ YES ®NO
<br />21d. WERE AUTOPSY FINDINGS'AVVN ABLE
<br />TO COMPLETE CAUSE '.OI, ATH
<br />_0 YES QNO
<br />22c. PLACE OF INJURY -At home, f1�nn, street, factory, office building, construction site, etc. (Sj
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />22f LOCATION oFINJURY:: STREET & NUMBER, APT.NO. CITY/TOWN
<br />STATE
<br />ZIp
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />May 13, 2026
<br />23b. DATE SIGNED Day, Yr.) ,
<br />Max 15.2026
<br />23c. TIME OF DEATH
<br />05:03 PM
<br />2.40 To thsbes1'af ft0 imovNed9e, death occurred at the time, date and place
<br />and din tatty cause(s) stated (Signature and 119e)
<br />Steven Husen, MD
<br />26a. HAS ORGAN OR
<br />0 YES
<br />2411, DATE SIGNED (Mo., Day, Yr.) /
<br />24b. TIME OF DEATH
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24d. TIME PRONOUN
<br />24s, on the basis or examination and/or investigation, In my *Orden 4et
<br />the time, date and place end due to the cause(*) stated. (Signature
<br />SSUE y • ATION BEEN CONSIDERED?
<br />e
<br />28, D)N:TOBAC;DIM CONTRIBUTE TO THE DEATH?
<br />DIY ❑: Nil ❑:PROBABLY 0 UNKNOWN
<br />27. NAME,'fTLE ANDADDRESS OF CERTIFIER (Type or Print
<br />Steven Husen, MD, 2116 W Faidley #400, Box 9802, Grand Island, • = <a, 68803
<br />28a. REG)STRAR'S..SIGNATURE
<br />26b. WAS CONSENT 0RA,NTl7
<br />Not Applicable H 28a la NO
<br />28b. DATE FILED BY REGIS
<br />May 21, 2026
<br />Tuned at':>;:.;::
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