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<br />STATE OF NEBRASKA
<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, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />I
<br />I
<br />I
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<br />S
<br />1
<br />DA TE<OF'ISSUANCE'
<br />7/1/2026 =
<br />LINCOLN, NEBRASKA
<br />2026051 80
<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: DECEDENT'S NAME (First: Middle, Last, Suffix)
<br />Sue M Gels AKA Susan M Gels
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Grand :Island, Nebraska
<br />T, SOCIAL SECURITY NUMBER
<br />508-52.0384' ..
<br />lib. FACiJJTY-NAME (If not Institution, give street and number)
<br />CHI Health St. Francis \
<br />5a. AGE - Last Birthday
<br />(Yre.)
<br />80
<br />Bb. UNDER 1 YEAR
<br />2. SEX
<br />Female
<br />5c. UNDER 1 DAY
<br />MOS.,
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL E Inpatient
<br />❑ ER/Outpatient
<br />❑DOA
<br />HOURS
<br />MINS.
<br />26 00193
<br />J. DATE OF DEATH{Ma, Day, Yr.)
<br />June 17, 2026
<br />6. DATE OF BIRTH (Mo., Day, Yr.)
<br />July 17, 1945; :.
<br />OTHER ❑ Nursing Home/LTC
<br />❑ Decedent's Home
<br />❑ Other (Specify)
<br />FaCilfty "'
<br />Sc. CITY OR TOWN OF DEATH (Include Zip Code)
<br />Grand Island 68803
<br />9a. RESIS DENCE-STATE
<br />Nebraska
<br />9b.000NTY
<br />Hall
<br />N. STREET AND NUMBER
<br />4257 Nevada Ave
<br />10a. MARITAL STATUS AT TIME OF DEATH ❑ Married ❑ Never Married
<br />❑ Married, but separated 0 Widowed ® Divorced ❑ Unknown
<br />11. FATHER'S NAME (First, Middle, Last, Suffix)
<br />Clarence Ostermeier
<br />1s. EvER IN U.S. ARMED FORCES?
<br />(Yes, No, or Unk) NO
<br />1S. METHOb OF DISPOSITION
<br />❑ audel Cl Donation:
<br />•® Cremation ❑ Entombment
<br />❑ Removal [!,Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />9c. CITY OR TOWN
<br />Grand Island
<br />Sc. APT. NO.
<br />4 INSIDE coy wan
<br />yes 0 No
<br />9f. ZIP CODE
<br />68803
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name
<br />14e. INFORMANT -NAME
<br />Tom Ostermeier
<br />16a. FUNERAL DIRECTOR SIGNATURE
<br />Kelley D Sheridan
<br />12. MOTHER'S -NAME (First, Middle, Maiden Surname)
<br />Velma Polzel
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />13R. FUNERA(. HOME NAME AND MAIUNO ADDRESS (Street, City or Town, State)
<br />'Alt Faiths Funeral Home, 2929 S. Locust Street, Grand Island, Nebraska
<br />16b. LICENSE NO.
<br />1439
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See Instructions and examples)
<br />ta. PART I. !Menthe chain of events- diseases, Injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE, Enter only one cause one line. Add additional lines N necessary.
<br />IMMEDIATE CAUSE:
<br />aatdEoaaTECAUSE (RPM a) respiratory failure
<br />dbeass 4r cnnduion:»sumw
<br />M death) DUE TO, OR AS A CONSEQUENCE OF:
<br />seganllaly list conditions, x b) Sepsis
<br />any, iota** the mum hated
<br />an Mate a
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />Enl.rdw UNDERLYING CAU$E elMetastatic B-cell lymphoma
<br />(disease or Injury that initiated
<br />the events resulting in death)
<br />WIT
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />t1)
<br />16. PART 0.OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting In the underlying cause given In P
<br />20 IF FEMALE:
<br />❑ NoS preOnsnt wipdn Mat year:.;
<br />P ❑ repmadatNOtardeath•
<br />0 Not pregnant, but pregnant within 42 days of death
<br />❑ Not 43 dayst pregnant, but pregnant to 1 year before death
<br />❑ unknaMn R pregiram W(tlihnjM p� year
<br />;Pi; DAZE OFINJUR'r (MO.. Day, Yr,)
<br />22d. INJURY AT WORK?
<br />❑;YES ❑NO
<br />/
<br />21a. MANNER OF DEATH
<br />Natural Ei Homicide
<br />,❑ Accident ❑ Pending Investigation
<br />0 Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />ElDriver/Operator
<br />❑ Passenger
<br />ElPedestrian
<br />El Other (Specify)
<br />to. RELATIONSHIP TO DECEDENT
<br />Brother
<br />16c. DATE (Mov Day, Yr.).:
<br />June 19, 2026
<br />STATE
<br />Nebraska
<br />$: / ZIP 00d t
<br />68801
<br />APPROXIMATE INTERVAL
<br />onset td daaltt
<br />< 1 Day
<br />onset to death
<br /><1 Week
<br />onset to elite'
<br />< 1 Month'
<br />ART I. 19. WAS MEDICAL. EXAMINE:
<br />OR CORONER CONTACTED?
<br />❑ YES ®NO
<br />21c. WAS AN AUTOPSY PERFOR ffilA7 ! ::
<br />❑ YES NO
<br />21d. WERE AUTOPSY F)NIDINGS AVAILABLE
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES ❑ NO
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction $
<br />22a. DESCRIBE HOW INJURY OCCURRED
<br />29/ LOCATION -OF U$JIRtY STREET & NUMBER, APT.NO.
<br />CITY/TowN
<br />STATE
<br />23a. DATE OF DEATH-0Mo., Day. Yr.)
<br />June 17 2026
<br />tab DATE SIGNEDDAo., Day, Yr.)
<br />Junk' 8 2026
<br />23c. TIME OF DEATH
<br />0101 PM
<br />lid. To ila ysetef Mly t(nowMdge death occurred at the b time date and place
<br />and diet to the Cauee(s) stated. (Signature and Title)
<br />Jennifer L. Brown, MD
<br />I b
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF MATH.
<br />24d. TIME PRONOUNCED
<br />24e. On the haste of examination and/or Investigation, In my opinion dealt otsu.hi d at
<br />the tine, date and plpue and due to the cause(*) stated, (9igneture and TNb)
<br />2fl DID :TOSACCO.USE CONTRIBUTE TO THE❑DEATH? R
<br />PROBABLY
<br />UNKNOWN
<br />27. NAME. TITLE AND AD SS OF CERTIFIER (Type or Print
<br />Jennifer L. Brown, MD, 729 North Custer Avenue, Grand Island, Nebraska,8803
<br />28a. REGISTRAR'S SIGNATURE
<br />26a. HAS ORGAN 0
<br />❑ YES
<br />ISSUE DONATION BEEN CONSIDERED?
<br />I;j NO
<br />'tafi fin, rzl�
<br />26b. WAS CONSENT GRANTED?
<br />Not Applicable N 26a is NO - :
<br />2eb. DATE FILED BY REGI8TRAR{lMb., Day, Yr,};
<br />June 22, 2026
<br />
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