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STATE OF NEBRASKA
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<br />WHEN THIS COPY CARRIES 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, WTAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />1
<br />i
<br />A
<br />DATE OF ISSUANCE
<br />6/22/2023
<br />LINCOLN, NEBRASKA
<br />20260523/ M3"AssissARATA---'114,18
<br />TATE 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.OECEDENTs-NAME (First, Middle, Last, Suffix)
<br />,Aimee Wiliam Vetter
<br />4. CITY AND STATE OR:TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Oswego, New York
<br />7. SCICIAI.SEC(IRITYNUMBER
<br />102 38-4981
<br />8a, AGE • Last Birthday
<br />(Yrs.)
<br />74
<br />eb. FACILITY -NAME fat not Institution, give street and number)
<br />2203 Rue De College
<br />8c, CYYY OR TOWN OF DEATH (Include Zip Cods)
<br />Grant Island 48803
<br />9a RESIDENCE4TATE
<br />Nebraska
<br />9b. COUNTY
<br />Hall
<br />5b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />5c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />ed. PLACE OP DEATH
<br />Ho5YITAL 0Inpatient
<br />Q ER/Outpatient
<br />❑ DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />23 06684
<br />3. DATE OF OEATh lino , DRy
<br />Mav 12, 2023.;
<br />)
<br />8. DATE OF BIRTft(Mo., Day,'Yr:)
<br />October 8::1948::.
<br />OTHER 0 Nursing Hom<C
<br />Decedent's Hone
<br />0 Other(Specify)
<br />Ied. COUNTY OF DEATH
<br />Hall
<br />id. STREET AND NUMBER
<br />2203 RueDe College
<br />10a: MARITAL 91''ATUSAT TIME OF DEATH® Married ❑ Never Married
<br />❑ Married, but separated 0 Widowed ❑ Divorced 0 Unknown
<br />De. APT. NO.
<br />9f. 2IP CODE
<br />68803
<br />iry;:IN3Iffi Ir replArO
<br />tOb. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden oaths
<br />Etta Pearson
<br />11. FATHER'S -NAME (First, Middle, Lest, Suffix)
<br />Robert James Vetter
<br />13. EVER IN U 8, ARMED:FORCES? Give dates of service If Yes.
<br />(Yes, No, or Unk.) Yes Dates Unknown
<br />F DISPOSITION
<br />[] "Ili
<br />❑
<br />oyt. ] Entombment
<br />O'Removat :❑ oahe► (Spe
<br />c
<br />i
<br />fy)
<br />14a. INFORMANT -NAME
<br />Etta Vetter
<br />16a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />12.MOTHER'S NAME (First, Middle, Maiden Surname
<br />Helen Louise Doviak
<br />1Ed. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />17a. FUNERAL HOME NAME AND MAILING ADDRESS (Street, City or Town,, State)
<br />All Faiths Funeral Home, 2929 S. Locust Street, Grand Island. Nebraska
<br />CAUSE OF DEATH (See Instru
<br />16b. LICENSE NO.
<br />CITY / TOWN
<br />Gibbon
<br />dons and examples)
<br />1S. PART I. Enter the chain of events- dN•ewu s, Injuries, or mpkNa4in M ionhat directly caused the as. DO NOT enter terminal events such cardiac west,
<br />respiratory an at. or ventricular fibrillation without showing the oenology. DO NOT ABBREVIATE. Enter only one cause on a lbw. Add additional Enos If necessary.
<br />IMMEDIATE CAUSE:
<br />IMOSEOIATECAe108(FI001 ':_. a) Multiple Myeloma
<br />dimim or tonoton futon;,'.
<br />in death)
<br />Sequentially Sat conditlona, ifany, bathos to min cause Sated
<br />Ente[ the UNDERl Ylt4DONDdI
<br />eau (dl•at'InjuryChat
<br />udti tad
<br />the
<br />e wants resulting In death)
<br />LAST
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b)
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />14b. RELATIONSHIP TO DECEDENT'.
<br />Spouse
<br />18e. DATE (Mo., Day...:Yr.) .'.
<br />Mav 16, 2023
<br />STATE
<br />Nebraska
<br />17b. neceds.
<br />68801
<br />APPROXIMATE INTERVAL
<br />onsstl;4dsttt(Y:
<br />24 Years
<br />olioh
<br />onset to d
<br />nset
<br />ott►t#atltll
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />18 :PART II.OTHER SIGNIFICANT CONDITIONS-Condltlons contributing to the death but not resulting in the und•rlying cause given In PART 1.
<br />NOn-Hodgkins Lymptrorna
<br />onse(to death
<br />it WAS MED)NCAI.:ExMIMINER :.::
<br />OR CORONER ONTA 1
<br />❑ YES ®NO
<br />220. IF FEMALE:.
<br />❑ Ilse Fr19nant tn55 f srst year
<br />❑'<ttot pnensnt, but preens* within 42 days of death
<br />❑ Not pregnant, but pregnant 43 days to 1 year before deathsteins❑::
<br />ir»pnaai st► of duth :::
<br />Unknowmm n EPr5Swi kr the put year
<br />22a.:;DATE OF INJURY (Mo, Day, Yr.)
<br />22d.INJURY AT WORK?
<br />❑YES ❑NO,
<br />21a. MANNER OF DEATH
<br />Natural El Homicide
<br />❑ Accident ❑ Pending Invastigatlalr
<br />❑ Suicide El Could not be det.rminad
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />0 OnvarlOperator
<br />QPaunper
<br />❑iPeeestnan
<br />❑ Dther (specify)
<br />21c. WAS AN AUTOPSY PERFORMED?
<br />❑ YES ® NO
<br />21d. WERE AUTOPSY RIDINGS AVAILAOLO
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES ❑ :.NO :::.
<br />22c. PLACE OP INJURY -At an t hone, n, street, factory, office building, combustion site,
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />j 221. GOCATKIN:OF INJURY" STREET:MI NUMBER, APT.NO. CITY/TOWN
<br />IV
<br />131 23a. DATE OF DEATH (Mo., Day, Yr.)
<br />A S May 12, 2023
<br />8"
<br />Ts 1st best of thy knowledge, death occurred at the there, aim and plat•
<br />E anddw e Maths) Maths) stated. (Signature and Tins)
<br />2 Gary Settle, MD
<br />23b. DATE SIGNED (Mo., Day, Yr.)ew M15.2023
<br />23c. TIME OF DEATH
<br />07:45 PM
<br />28. DID TOBACCO USE CONTRIBUTE TO THE DEATH?
<br />fl YES so NO Li PROBABLY 0 UNKNOWN
<br />.S
<br />(1
<br />STATE SfP t
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />TIME24b. TOF DEATH
<br />24e. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24d. TIME PRONOUNCED
<br />240. On tea bait. of examination and/or Investigation, In my opinion dswh bfcdlred at
<br />the time, date and place and due to the cauea(a) stated. (Signature aqd Tide) ..
<br />26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />❑ YES RiNO
<br />27. NAME, TITLE AND ADpi7Ess OF CERTIFIER (Type or Print
<br />Gary Settle, MD,.2116 W Faidley #400, Box 9802, Grand Island, Nebraska, 68803
<br />tab. WAS CONSENT GRANTED?
<br />Not Applicable if 26a Is NO ❑ YES
<br />28a REGISTRAR'SSIGNATURE``-e/?, yG t_�s-
<br />28b. DATE FILED BY REGISTRAR (Mo.,Day,Yr.)
<br />May 18, 2023
<br />Donation
<br />18. METHOD O
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