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I§ &MOMS S tit infk ti:i(IU14111i F NEBRASKA tFl as r.:; za.WaVORrn .. =..wa r ate ausg est NI aifyNaitir, ` ?.atNtllYfiaatx� 3 giatte 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 202101200 SARAH BOHNENKAMP ASSISTANT STATE REGISTRAR DEPARTMENT OF HEALTH AND HUMAN SERVICES STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES CERTIFICATE OF DEATH 2014296 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 5a AGE - Last Birthday (Yrs.) 85 5b. UNDER 1 YEAR Sc. UNDER 1 DAY MOS. DAYS HOURS MINS. 6. DATE OF BIRTH (Mo., Day, Yr.) December 13, 1934. c 0 U c 9C C c 0 cry m at A; '0 d ox ra E u 0 c 7. SOCIAL SECURITY NUMBER 505-38-6440 8b. FACILITY -NAME (ffnot institution, give street and number) CHI Health St. Francis 8c. CITY OR TOWN OF DEATH (Include Zip Code) Grand Island 88803 9s. RESIDENCE -STATE Nebraska 9d, STREET ANO NUMBER. 4001 Kay Ave 9b. COUNTY Hall 10a. MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married 0 Married, but separated 0 Widowed 0 Divorced 0 Unknown 11. FATHER'S -NAME (First, Middle, Last, Suffix) Grant Bickford 8a. PLACE OF DEATH HOSPITAL ® Inpatient ❑ ER/Outpatient ❑ DOA 9c. CITY OR TOWN Grand Island OTHER 0 Nursing Home/LTC 0 Decedent's Home ❑ Other (Specify) I8d. COUNTY OF DEATH Hall 9e. APT. NO. 9f. ZIP CODE 68803 Hospice Facility" 95. INSIDE -eITY LIMITS II YES O No 10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden name Dorla Giltz 12. MOTHER'S -NAME (First, Middle, Maiden Surname) Dorothy Chamberlain 13. EVER IN U,5. ARMED FORCES? Give dates of service if Yes. (Yes, No, or Unk.) NO 14a. INFORMANT -NAME Dorla Bickford 14b. RELATIONSHIP TO DECEDENT. Wife 15. METHOD OF DISPOSITION ❑ `Burial ❑ Donation NI Cremation ❑ Entombment ❑ Removal ' 0 Other (Specify) 16a. EMBALMER -SIGNATURE Katie M. Smvdra 16b. LICENSE NO. 1454 16c. DATE (Mo., Day, Yr.) October 18. 2020 16d. CEMETERY, CREMATORY OR OTHER LOCATION CITY / TOWN Central Nebraska Cremation Services Gibbon STATE Nebraska 17a. FUNERAL HOME NAME AND MA UNG ADDRESS (Street, City or Town, State) All Faiths Funeral Home, 2929 S. Locust Street, Grand Island, Nebraska CAUSE OF DEATH (See instructions and examples) 1e. 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 one line. Add additional lines If necessary. IMMEDIATE CAUSE: a) Intracranial Hemorrhage IMMEDIATE CAUSE (Final disease or condition resulting. in death) Sequentially list conditions, if any, leading to the cause listed on lino a. .. Enter the UNDERLYING CAUSE (disease or Injurythat initiated the events resulting in death) LAST DUE TO, OR AS A CONSEQUENCE OF: b) Hypertension 17b. Zip Code 68801 APPROXIMATE INTERVAL onset to death. 72 Hours 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 IL OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting in the underlying cause given In PART I. Hypertension, Cerebeliar Ataxia ,monoclonoal Gammopathy,PVD 19. WAS MEDICAL EXAMINER OR CORONER CONTACTED? ❑ YES ®NO X20. IF FEMALE: ❑ Not prognentwithin past year 0 Pregnant at time of death ❑ Not pregnant but pregnant within 42 days of death ❑ Not pregnant, but pregnant 43 days to 1 year before death ❑ Unknown U pregnant within the past year 21a. MANNER OF DEATH Natural ❑ Homicide ❑ Accident ❑ Pending investigation 0 Suicide ❑ Could not be determined 21b. IF TRANSPORTATION INJURY ❑ Driver/Operator 0 Passenger ❑ Pedestrian ❑ Other (Specify) 21e. WAS AN AUTOPSY PERFORMED? ❑ YES El NO 21d. WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE CAUSE OF DEATH? DYES ONO C w E m Ta 22a. DATE OF INJURY (Mo. Day, Yr.) 22b. TIME OF INJURY 22c. PLACE OF INJURY -At home, farm, street, factory, office building, construction site, etc. (Specify) 22d. INJURY AT WORK? ❑ YES ❑NO. 22e. DESCRIBE HOW INJURY OCCURRED 22f. LOCATION OF INJURY STREET & NUMBER, APT.NO. CITY/TOWN fli 0 et 23a. DATE OF DEATH (Mo., Day, Yr.) c ia September 30, 2020 F „, 23b. DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH S u October 2, 2020 10:20 PM a� O Stl. To the Mst o! my knowledge, death occurred at the time, date and plade i$f sntl due to tlw cause(s) stated. (Signature and Title) A. Lij Jane A. McDonald, MD a a. 26. DID TOBACCO USE CONTRIBUTE TO THE DEATH? 0 YES I) NO ❑ PROBABLY 0 UNKNOWN STATE ZIP CODE 24a. DATE SIGNED (Mo., Day, Yr.) 24b. TIME OF DEATH 24c. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD 24e. On the basis of examination and/or Investigation, M my opinion death OCCerred.at the time, date and place and due to the cause(s) stated. (Signature and Title) 26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? ❑ YES IR] NO 26b. WAS CONSENT GRANTED? Not Applicable H 26a Is NO 0 YES 0 N 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 N)