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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BEA TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICW'IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />3'
<br />DATE OF ISSUANCE=
<br />7/17/2026
<br />UNCQLN, NEBRASKA
<br />202604842.
<br />5),110..
<br />4'
<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. DEC.EDEN!rs.a . E (First; : /kiddie, Last,.. Suffix)
<br />Fred John;; Becker
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand Island, Nebraska
<br />7 SOCIAL SECURITY NUMIRMI
<br />505-48-6147 .
<br />5a. AGE • Last Birthday.
<br />(Y►e.)
<br />88
<br />Sb. FACIUTY-NAME (If not Institution, give street and number)
<br />Grand Island Regional Medical Center
<br />&r. CITY OR TOWN OF DEATH (Include Zip Code)
<br />Grand Island 68803
<br />9a, RESIDENCE -STATE
<br />::Nebraska
<br />!U.STREETANDNUMBER ':
<br />11,1 N, Hot' and Avenue
<br />9b.000NTY
<br />Hall
<br />10a. MARITAL STATUS AT TIME OF DEATH ® Married ❑ Never Married
<br />0 Mewled, but *operated ❑ Widowed 0 Divorced ❑ Unknown
<br />11, FATHER'S -NAME (First, Middle, Last, Suffix)
<br />Bernard Becker
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No or Unk.) NO
<br />15MET#hODOFDtSPOSITION
<br />❑ B »1al 0 D ntadot>
<br />® Carnation\ Q Entoyaiinent
<br />0 Removal ❑ Other(Speclfy)
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL ® Inpatient
<br />❑ ER/Outpatient
<br />❑ DOA
<br />9e. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />26 08682
<br />3. DATE OF DEA IFt M c
<br />July 7, 2026
<br />6. DATE OF BIRTH (Mo., Day, Yr.)
<br />December 6, 1937
<br />OTHER 0 Nursing HomNLTC
<br />❑ Decedent's Home
<br />❑ Other (Sp«ah)
<br />Sd. COUNTY OF DEATH\
<br />Hall
<br />Be. APT. NO.
<br />ef. ZIP CODE
<br />68803
<br />❑`Noipkse PACO*/
<br />9g. iN810E' CtTYLPIrr;S '
<br />rvEs O> r
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name
<br />Charlette Hartwig
<br />12. MOTHER'S -NAME (First, \ Middle, Maiden Surname)
<br />Anna Kroeger
<br />14a. INFORMANT -NAME
<br />Charlette Becker
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Kelley D Sheridan
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />1Tlw. FUNERAL HOME NAME AND MA UNO ADDRESS (Street, City or Town, State)
<br />All Faiths Funeral Home, 2929 S. Locust Street, Grand Island, Nebraska
<br />te. PART I. Enter*, ime
<br />teaQkm04.44
<br />ptety att, CO w
<br />16b. LICENSE NO.
<br />1439
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examples)
<br />chain of Ms- *Moues, Injuries, or complications -that directly caused the death. DO NOT enter terminal events such u cardiac arrest,
<br />r fibi1 a Ion Without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on: a line, Add additional lines If necessary.
<br />IMMEDIATE CAUSE:
<br />lhedilliRTEIMMIEflhatn
<br />leseer:e:r:dondplanus lthI ,
<br />in death)
<br />sevuentie !y Net condition lf :;..
<br />*Ming totinecdugBabdf
<br />tin nrld:
<br />140. RELAT1ONSFEP TO DECEDENT
<br />Spouse /
<br />16c. DATE (Me ,13Ny,
<br />July 7, 2026 .:
<br />STATE
<br />Nebraska
<br />1Tb.Crfs
<br />68801:
<br />J
<br />a) acute hypoxic respiratory failure
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b) lung cancer
<br />DUE TO OR AS A CONSEQUENCE OF:
<br />enterers tNMERLYINo cAtlsE' D)
<br />(disease or Mary that Initiated
<br />the tents resulting th (Wth) DI)E TO, OR AS A CONSEQUENCE OF:
<br />LAST :)`\
<br />i
<br />IS, PANTIE. OTHER SIGNIFICANT CONDITIONS-Cond,tions contributing to the death but not resulting in the underlying cause given In PART I.
<br />2t41P FEMALE:
<br />❑ NetpnpneMVNlhihpesty5$r
<br />0 Not pregnant, but pregnant within 42 days of death
<br />Not Stagnant. but pregnIS 43 days tot year before Math
<br />Unknown if.preynant *Ailiit) is past year
<br />2Ya. DATE OFMIJURY(Mo,,:Day, Yr.)
<br />21a. MANNER OF DEATH
<br />® Natural ❑ Homkad.
<br />0 Accident 0 Pending Investigation
<br />❑ Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />0 Driver/Operator
<br />❑ Funnels'.
<br />❑ Pedestrian
<br />❑ Other (Specify)
<br />APPROXIMATE INTERVAL
<br />onset to deetif.:.'
<br />2 Days
<br />onset to dwIi
<br />onset to death
<br />19. WAS MEDICAL>.EXAMINEI
<br />OR CORdNER CONTACTED?
<br />❑ YES ®NO
<br />21c. WAS AN AUTOPSY PERFORMECr►
<br />❑ YES paiMi
<br />215E WERE AUTOPSY FIt INGS AVAILABLE
<br />TO COMPLETE CAINE OF DEATH?
<br />❑ YES ❑ NOD.
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building,construction sib, etc. ¢Ey)
<br />22d. INJURY AT WORK?
<br />C yes ❑;M0
<br />22f LOCATION
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />INJURY STREET It NUMBER, APT.NO. CITY/TOWN
<br />STATE
<br />42111
<br />21a. DATE OF DEATH (Mo., Day, Yr.)
<br />July 7, 2026
<br />Sit, DATE SIGNED (Mo Day, Yr.)
<br />1IU 7, 2026:::':'""'
<br />lid To tla Mat Of hay ldrowdsdge, death occhnr at tatna time, dab and place
<br />and deal to thecsuse(s)atated. (Signature an Tale)
<br />Davin Scott, APRN
<br />N
<br />23c. TIME OF DEATH
<br />04:35 AM
<br />v4.:DID;TOBACCO USE C w:MisUTE TO THE DEATH?
<br />I� YES ❑ NO PROBABLY ® UNKNOWN
<br />wl'f. NAME, *TA AND ADDRESS OF CERTIFIER (Type or Print
<br />Devin Scott, APRN, 3533 Prairieview St, Grand Island,/ Nebraska, 68803
<br />4-17
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />24d. TIME PRONOUNCED
<br />11EA4
<br />24*. On the basis of examination and/or . in My opinion death **SUMS*
<br />the
<br />time, dab and place and diva to the cause(4)sted. (Signature a and Tgb)
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑ YES RI NO
<br />(
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable if 26a Is NO ❑ YOB
<br />28b. DATE FILED BY REGISTRAR (Mo Day, Yr.}
<br />July 8, 2026
<br />
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