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<br />„„,,,,a„,.0A%.,44,,,,61,004•A0001;,,mayo
<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 />Re1/6":400
<br />'M&M &Aik
<br />2 0 220 b 1 SARAH BOIINENICAIVIP .
<br />•
<br />A 5 4 ASSISTANT STATE FtEGISTRAll'.
<br />• • DEPARTMENT OF HEALTH
<br />AND HUMAN SERVICES
<br />- ' STATE OF NEBRASKA - DEPARTMENT OF HEALTH AND HUMAN SERVICES
<br />CERTIFICATE OF DEATH . 21 16411 ...
<br />1. RrfEirIrs41A!.#0,,i(ff...t., Middle, Last, Suffix)
<br />' •-..-.•:•:•:-........:,
<br />Ronald Francis Beck . Male Novembeilk2bZri. ..i.......E.!...:::::::.i l':•.'......g....
<br />.., ,.:........ ..... ............ .... ....
<br />Z SEX 3. DATE OF DEA101L1HP., Dii)kli'.)... :.......:14
<br />4. CITY aielb STATEORTERRITPRY, OR FOREIGN COUNTRY OF BIRTH 5a.AGE • Labtelrthdejt.
<br />. -
<br />..... ... ....
<br />MOS. DAYS HOURS MINS.
<br />4 S0.0§10E700fallY1011.., '''' ' ' ,
<br />;:,..,:..G.rand Island Nebraska_ : . ,. v: :..,
<br />JUIN' Z8,-,1 94 '"'''' ' ''':: '''''.;'
<br />.. ,
<br />....
<br />-;•00s;52;0124: ....,.."...:::::,..'"::::::::::"Z''",..-...0.,- - : , ' 8* PI-4qE 9! ..,..0E7t, .:-.............. ri H meiLit i ,..:',,:it IIPI..Ii ft0#'4'::::......." '• l'•.":".:•::.N::".",.!.:!': ."(
<br />'"....._.,...........HOSFITAL" Eg$I Inpatient OTHER L.,1 Nursing o ,...., .....).,,, .,::,.......:. ..ii ............,,,..,:.
<br />SO. FACILITY -NAME (If -not give street and number) ' ' )D EFVOu patient 0 Decedent's Home " - , ...- '''
<br />:. C1711.:t1ep1th.....$1,.:Frioii,y:
<br />... .... .. ...
<br />0 DOA 0 Other (Specify) :.:..,..., ., . .. .... ' , ....,.....2.....
<br />- .:..::"*J. ';'...i:::.,.:i.:. ....*•::".*, •••:::..".":.",::. :::::";.::, :•:"•,:,,....,-....••::::.:...:.
<br />fib. UNDER 1 YEAR
<br />Sc. UNDER 1 DAY
<br />6. DATE OF BIRtHielo.,
<br />, ' •
<br />". • sc."411Y.OR TOWN 6)P;GGATH (Include Zip Code)
<br />13t and Island .68803
<br />9a. RESIDENCE -STATE 9b. COUNTY 9e. CITY OR TOWN
<br />Nebraska.' Hall Grand Island
<br />Hall ... •
<br />Od. STREET
<br />29112.800cock Place
<br />d 0 Unknown
<br />1o..'00-• • dowed L., Divorce
<br />BATH IRI Marr
<br />t3 Married, Never Married
<br />Married
<br />90. APT. NO.
<br />9f. ZIP CODE
<br />68803
<br />1YES NO
<br />• •• • • ,•••••••••••••••• ••• • •• ••••.••••••••••••
<br />1D13 NAN)D,.OPtPODSE •• Middle,"'" Suffix) ••,
<br />i.
<br />• .....
<br />Georgia : '..• •
<br />1 .0i.frj1" Last, Suffix) .:12.MGTHER'S;NAME (First, Middle, Maiden Surname)
<br />Frances Zwiec
<br />13, vett IN UAL ARAM/FORCES? Give dates of service if Yes.
<br />(Yes,No, or Unk.) No
<br />16. mFroOp OF DISPOSITION
<br />(Gpeeiei)
<br />14a. INFORMANT -NAME
<br />Georgia Beck
<br />lea. EMBALMER -SIGNATURE
<br />Katie M. Strydra
<br />16b. LICENSE NO.
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION. CITY / TOWN
<br />Central Nebraska Cremation Services Gibbon
<br />17a. FUNERAL:HOME..NAMEAND MA 14NG.:AppREss (Street, City or Teeet.,State),,,. •
<br />All Faiths Funeral Home 2929 S Locust Street:: Grand Island Nebraska
<br />14b. RELATIONISfifPlo'DEOEDENI`
<br />Spouse ,"
<br />16c. DATE
<br />........
<br />November29, 2021
<br />Nebraska
<br />68801
<br />•••••• • ."••••'•,••••
<br />•••CAU.S.E.:.0.FOSATNIS00$4t1StrtietibrItrarlitV0XabigleS).......":
<br />••••:
<br />5. PARTI. Enter the titein of eyen$4ibeeehs, injuries, Or cemptications-that directly caused the death. DO NOT enter terminal events .000400.0001i00..erra!!t, • ." • ••••••••• • •""••••"""":"..::::::AP1$4.0)Diii)ATEINTERVA1..,":".4":"
<br />thiiiiIng•the etiology.' Do NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary.
<br />.•,•••••• ••• -•••••••":"
<br />, .............. . .• . • . .
<br />IMMEDIATE CAUSE
<br />• ••• • • • • •
<br />• . , • • •
<br />2 Years
<br />ENCE OF:
<br />. .......
<br />b1HoteOrtChroni.c respiratory failure
<br />,'"•••••••••••••-•-•••
<br />M in death) DUE TO, OR AS A CONSEQ
<br />Sequentially list condItIons If'
<br />Any, feeding to the cause listed
<br />onlin6 8 DUE TO, OR AS A CONSEQUENCE C
<br />Enterlhe tINDEWnN°'DA
<br />46' t(pdelitelky4ieents'°rinlurY
<br />resulting in death) titJE TO, OR AS A CONSEQUENCE OF:
<br />::1041i1ADIA144Auti pulmonary fibrosis
<br />ortiltet'to death
<br />,
<br />2 Weeks
<br />onsettk:000:
<br />onset to death.
<br />1co..AR,r1ii:::0ThErt:400i0i0.4.0T-',CONOTIONS4onditions contributing to triepoathoonctfi.0054000k.#1000derlying cause given in PART I.
<br />0Pre9ttltit CC data Of dose '
<br />• 1:1•:•••Isesiiiaignant,";SatiatigiteinvialtIn 42 days of death
<br />0 Not pregnant, but pregnant43 days to 1 year before death
<br />year
<br />22d, INJURS' ATWORK/'
<br />DYES ONO
<br />21a. MANNER OF DEATH
<br />IZ Natural 0 Homicide
<br />0 Accident 0 Pending inveetigatitin
<br />0 Suicide 0 Could not be determined
<br />22b. TIME OF INJURY
<br />19. WAS ME)40t:OK•MaINEI)::::
<br />OR CORONEWOONTA41180
<br />YES , NO
<br />. , •
<br />21b,...IF TRANSPORTATION INJURY 21c. WAS AN AUTOPSY FERPORMAP? :. ":: .:
<br />Eybeienoperator ,.., ........,:.: .:.:, ."'.:',:"..:.!:' ..,:":ii:,.:''''..:A".::: . ',:.:".,';', '' .:..,'.....i.::•;i:,,.:,..
<br />El: passenger U YES t1KI!09...... ..,...i.,"..!....1..i.g.
<br />0, Pedestrian 21d. WERE ADTOPSYANDINOGAILABLE .. ''..::::1:::.......:.... ,.•
<br />. . ,
<br />TO COMPLETE CAUSE OF DEATH? 1 '
<br />0 Other (Specify)
<br />22c PLACE OF INJURYAt home, farm, street factory, office building, construction elle,.
<br />22e pesombe HOW INJURY OCCURRED
<br />62f.itiOCA1OtiM, l'NUMBER, APT.NO. CITY/TOWN. ••••
<br />a.
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />November22. 2021
<br />23b. L1ATE'SIONED,(Mo., Day, Yr.)
<br />NGVert1b16649, 2,021
<br />STATE
<br />23c. TIME OF DEATH
<br />04:10 AM
<br />23d., Tams ttett,O.f.my.anowiedett,eeith occurred at the time, date and place
<br />and due */ the aatitte(s) stated. (Signature and Title)
<br />Gary 'Settle,
<br />0
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TIME OF DEATH
<br />24d. TIME PRONOUNCED DEAD
<br />440. 00',Ihe*eils of examination and/or Investigation, In my opinion deeitilaaiiireci.-.'"
<br />the ttaxi; date and place and due to the cause(s) stated. (Signature M)tirtle)
<br />•, •
<br />5. b UNKNOWN YES EIN04.:1
<br />YOBACODustooNTR CONTRIBUTE TO' THE DEATH? 26a. HAS ORGAN OR TISSUE DONATION -BEEN CONSIDERED?
<br />EOBABLY
<br />27 1:1:7.i.i:T.-Li'V4)7,.RE".,:60.,,.6F.,..",CERTIFIER (Type or PrintFaidley #400, Box 9802, Grand isiart d NObriftkk'68803,'.'
<br />28a..REGISTRAR'S SIGNATURE' j
<br />....•
<br />Not Applje0010:11".26:kitt,„NO"',"",","„"."'""...;
<br />• 28b. DATE FILED BY REotsTRAH"(mo Day,. Yr.).. • „ • " •i,
<br />• '.
<br />December 2, •,,-:,,g,f;,!•• ...,•::,',.•::?.': '''''''
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