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FPAaut88tgt�1V'Ni7'r$i3reo�t4��1��'s �#� uR ��3Ia))dt64�)93`�fd.'rin�t`,��d IF73WIN,Y,I,tW1AD9tJ 'non'.il�@'8iFY3 .: . t2tyA4g4Wa drfttt@9'liii' (W@@@7gaxx- asxr6t9NdAF' VafFIr WHEN < THIS COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE 10/28/2020 LINCOLN, NEBRASKA 202101199 SARAH BOHNENKAMP ASSISTANT STATE REGISTRAR DEPARTMENT OF HEALTH AND HUMAN SERVICES STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES CERTIFICATE OF DEATH 2014296 O aru S 1. DECEDENTS -NAME (First, Middle, Last, Suffix) Ronnie Lee Bickford 2. SEX Male 3. DATE OF DEATH (Mo.,;Day, Yr.) September 30, 2020 4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH Kearney, Nebraska 7. SOCIAL SECURITY NUMBER 505»38-6440 55. AGE - Last Birthday (Yrs.) 8b. FACILITY -NAME (If not Institution, give street and number) CHI Health St. Francis 8c. CITY OR TOWN OF DEATH (Include Zip Code) Grand Island 68803 9a. RESIDENCE -STATE Nebraska 9d. STREET AND NUMBER 4001 Kay Ave 9b. COUNTY Hall 85 5b. UNDER 1 YEAR 5c. UNDER 1 DAY MOS. DAYS 8a. PLACE OF DEATH HOSPITAL ® Inpatient ❑ ER/Outpatient ❑ DOA 9c. CITY OR TOWN Grand Island HOURS MINS. 8. DATE OF BIM (Mo., Day. Yr.) December 13, 1934 OTHER 0 Nursing Home/LTC ❑ Decedent's Home ❑ Other (Specify) 18d. COUNTY OF DEATH Hall Be. APT. NO. 9f. ZIP CODE 68803 ❑ Hospice Facility 9g. INSIDE CITY LIMITS'r: (it YES. 0 NO 10a. MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married ❑ Married, but separated 0 Widowed 0 Divorced 0 Unknown 10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name Dorla Giltz 11. FATHER'S -NAME (First, Middle, Last, Suffix) Grant Bickford 12. MOTHER'S -NAME (First, Middle, Maiden Surname) Dorothy Chamberlain 13.'EVER IN U.S. ARMED FORCES? Give dates of service if Yes. (Yes, No, or Unk.) No 14a. INFORMANT -NAME Dorla Bickford 14b. RELATIONSHIP TO DECEDENT Wfe 15. METHOD OF DISPOSITION ❑ Burial ❑ Donation Cremation, ❑Entombment ❑ Removal ' ❑ Other (Specify) 16a. EMBALMER -SIGNATURE Katie M. Smydra 16b. LICENSE NO. 1454 16c. DATE (Mo., Day, Yr.) October ,18, 2020 18d. CEMETERY, CREMATORY OR OTHER LOCATION Central Nebraska Cremation Services CITY / TOWN Gibbon STATE Nebraska 17a. FUNERAL HOME NAME AND MAILING ADDRESS (Street, City or Town, State) All Faiths Funeral Home, 2929 S. Locust Street, Grand Island, Nebraska 17b. Zip Code 68801 CAUSE OF DEATH (See instructions and examples) ta. PART I. Enter the chain of events- -diseases, Injuries, or complications.that directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary. IMMEDIATE CAUSE: a) Intracranial Hemorrhage IMMEDIATE CAUSE (Float disease of condition resulting in death) Sequentially list conditions, if any, leading to the cause listed on linea. Enter the UNDERLYING CAUSE (disease or injury that initiated the events resulting In death) LAST APPROXIMATE INTERVAL onset tO. death 72 Hours DUE TO, OR AS A CONSEQUENCE OF: b) Hypertension onset to death DUE TO, OR AS A CONSEQUENCE OF: c) onset to death DUE TO, OR AS A CONSEQUENCE OF: d) onset to death 18. PART R. OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting in the underlying cause given In PART I. Hypertension, Cerebellar Ataxia ,monoclonoal Gammopathy, PVD 19. WAS MEDtCAL EXAMINER OR CORONER CONTACTED? ❑ YES ® NO 20.1F FEMALE: ❑ Not pregnant within pant year 0 Pregnant at time of death 0 Not pregnant, but pregnant within 42 days of death ❑ Not pregnant, but pregnant 43 days to 1 year before death 0 Unknown If pregnant within the past year 22a.:DATE OF INJURY (Mo., Day, Yr.) 22d. INJURY AT WORK? O YES. ❑ NO 21a. MANNER OF DEATH ® Natural 0 Homicide. 0 Accident 0 Pending Investigation 0 Suicide ❑ Could not be determined 22b. TIME OF INJURY 21b. IF TRANSPORTATION INJURY 0 Driver/Operator 0 Passenger ❑ Pedestrian ❑ Other (Specify) 21c. WAS AN AUTOPSY PERFORMED? ❑ YES ® NO 21d. WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE CAUSE OF DEATH? ❑ YES ❑ NO 22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction site, etc. (Spec' 22e. DESCRIBE HOW INJURY OCCURRED 221. LOCATION OF INJURY STREET & NUMBER, APT.NO. 23a. DATE OF DEATH (Mo., Day, Yr.) September 30, 2020 CITY/TOWN 23b. DATE SIGNED (Mo., Day, Yr.) October 2.2020 23c. TIME OF DEATH 10:20 PM 23d. To the beet of my knowledge, death occurred at the time, date and place end due to the cause(s) stated. (Signature and TRH) Jane A. McDonald, MD 25. DID TOBACCO USE CONTRIBUTE TO THE DEATH? Q YES 14 NO 0 PROBABLY 0 UNKNOWN STATE 24a. DATE SIGNED (Mo., Day, Yr.) 24b. TIME OF DEATH ) ZIP CODE 24c. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD. 24e. On the basis of examination and/or Investigation, In my opinion death occurred: at the time, date and place and due to the cause(s) stated. (Signature and Tie) u8 26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? ❑ YES ®NO 28b. WAS CONSENT GRANTED?:::.. Not Applicable If 28a is NO El YES 0 NO 27. NAME, TITLE AND ADDRESS OF CERTIFIER (Type or Print Jane A. McDonald, MD, 800 N Alpha Street, Grand Island, Nebraska, 68803 28a. REGISTRAR'S SIGNATURE 28b. DATE FILED BY REGISTRAR (Mo., Day, Yr.) October 26, 2020 0) -4