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DOUGLAS COU
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF DOUGLAS COUNTY; NEBRASKA, IT CERTIFIES THE
<br />DOCUMENT BELOW TO BE A -TRUE COPY OF THE ORIGINAL RECORD ONPILE:WITH THE DOUGLAS COUNTY
<br />HEALTH DEPARTMENT, VITAL STATISTICS SECTION, WHICH IS THE LEGAL' DEPOSITORY FOR VITAL RECORDS
<br />S
<br />B
<br />OAre ©F 138i NCE
<br />12/04/2025
<br />OMAHA, NEBRASKA
<br />2025071 03
<br />LINDSAY HUSE:MPH, DNP, RN
<br />HEALTH DIRECTOR
<br />DOUGLAS COUNTY HEALTH DEPARTMENT
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALJH AND HUMAN SERVICES
<br />CERTIFICATE OF .;DEATH
<br />1. DECEDENTS -NAME (First, Middle, Last, Suffix)
<br />Marlin Carl Quaring
<br />City AO:STATE ORTERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Carrie, Nebraska
<br />7, SOCIAL SECURITY NUMBER
<br />r 505470-82.10
<br />Ob. FACIL#7Y-NAME.(Ifnot:Instltution, give street and number)
<br />6632'N 149th Ave'
<br />8c. CITY OR TOWN OF DEATH (Include Zip Code)
<br />: Omaha 681:16::..
<br />9a. RESIDENCEi'ATE: >'
<br />Nebraska,:
<br />9d. STREET AND NUMBER
<br />16450 W Nebraska Hwy 2
<br />9b. COUNTY
<br />Hall
<br />C&.AAA AL S7ATr1S:AT:TIME OF DEATH 0 Married ❑ Never Married
<br />0In,Martifiti,,itit soparated ElWidowed 0 DivorcedI 0 Unknown
<br />11. FATHER'S -NAME (First, Middle, Last, Suffix)
<br />Leo L Quarina
<br />13. EVER.IN U.S ARMED FORCES?
<br />(Yes, NO;or'tnrc.): Yes
<br />15. METHOD D CIF DISPOSITION
<br />0 Burial 0 Donation
<br />® Cremation\❑ Entombment
<br />❑` etrf oval :::❑:Otthe ;(Spedfy►
<br />ta, AAGE: LaatBlrthday:
<br />(yris.)
<br />Sb. UNDER;a YEAR
<br />• ::MOS::: .
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HO.SPiTAL .El Inpatient
<br />ER/Outpstient
<br />❑ DOA
<br />0:::crrY OR::TOWN
<br />Cairo :':.
<br />2. SEX
<br />Male
<br />6c. UNDER 1 DAY
<br />HOURS
<br />MINS.
<br />,rr
<br />3. DATE OF DEATH (Mo., Day, Yr.)
<br />(-November-29, 2025 .
<br />6. DATE OF BIRTH
<br />October 194
<br />OTHER 0 Nursing Home/LTC
<br />0 Decedent's Home
<br />Ea Other (Spec aUghterBHOIhe
<br />8d. COUNTY OF DEATH
<br />Douglas
<br />9e. APT. NO.
<br />if. ZIP CODE
<br />68824
<br />80
<br />0 }twice Facility
<br />9g. INSIDE CITY:WAITS
<br />❑ YES ®NO
<br />:1.013.::NAME::OF SPOUSE (Fired.::: ;Middle, Last, Suffix) If wife, give maiden natea
<br />12. MOTHER'S -NAME (First, Middle, Maiden Surname)
<br />Myrtle Ruth Nordstrom Tracy
<br />14a. INFORMANT -NAME
<br />Michelle KQuoting< :.
<br />lea. FUNERAL DIRECTOR SIGNATURE::
<br />Jack A Critchfield
<br />led. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Omaha Crematory
<br />LICENSE NO.
<br />1525
<br />CITY I TOWN
<br />Omaha
<br />17s. FtINfERALNIME',NAME AND MA LING ADDRESS (Street, City or Town, State)
<br />Omaha Cremation Services 4138 S 144th St, Omaha, Nebraska
<br />CAUSE OF DEATH (See instructions.and examples)
<br />e. RkEt7lrEr:tliacham of t - lewas; Injuries, complications -that directly cau itd. the deat , DO NOT entefterminalav sets such as cardiac arrest,
<br />events- .t or
<br />nepiratery atrist :verdtiytiierilbdllation without showing the etiology. DO NOT ABBnEVIATE. Enter only cause an a lute :Add additional lines If necessary.
<br />IMMEDIATE CAUSE: . .
<br />IMMEDIATE CAUSE (Final a) Bilateral lung nodules, with liver lesions, bone lesions, and bladder lesion
<br />disease or condition resulting
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />setuantieliSet cgndittone, If : b)
<br />any;tead>aito Ms cauw feted
<br />online.
<br />DUE TO, QIAS A CONSEQUENCEAF:
<br />Meet the.NOEIcLYINO;CAUSE c)
<br />>(dlpeaae orinWry diet MOMS
<br />th►:evants:reeu ny In d' :dhl,;::, ;'. DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />18. PART II. OTHER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting In the underlying cause given in PART I.
<br />Chroriii; ©bstmotit e'pulmonary disease
<br />20.IFFEMALE; >,
<br />❑ Not pregnant within past year
<br />❑ Pregnant at time of death
<br />1:3{{ teir4: pragnint .hut (uegii at within 42 days of death
<br />Not pr . milli; aut.yfagnant 43 days to 1 year before death
<br />Upknown ff ptegnaiitvAthin the pest year
<br />22a. DATE OF INJURY (Mo., Day, Yr.)
<br />22d.INJUR! AT1IiroRif?
<br />21a. MANNER OF.DEATH
<br />El Natural 0 Homicide
<br />)❑ Accident 0 Pending Investigation
<br />0 Suicide ❑ Souk* qut bedetennineds
<br />22b. TIME OF INJURY
<br />21b: IFT72ANSPORTATION INJURY
<br />❑Driver/Operator
<br />❑ Passenger
<br />P.edastrfan
<br />• Otlraf (Specify)
<br />14b. RELATIONSHIP!. DECNT.
<br />Daughter
<br />< EDE....
<br />lec DATE 0.10.,>Day, Yr.)?.»:-
<br />December 1, 2025
<br />STATE
<br />Nebraska
<br />17b ZIp:Code ;, .. :
<br />68137
<br />APPROXIMATE€iNTERYI;:.
<br />onsetto`death
<br />16 Daya
<br />bttast to death -
<br />as
<br />19. WAS MEDICAL EXAMINER
<br />OR CORONER CONTACTED?
<br />❑ YES .11;16
<br />21c. WAS AN A
<br />❑ Yes
<br />21d. WERE. AUTO PSY:F'INDiNGSAVAtkABLE�
<br />TO COMPLETE C.AUSEOF tfE#tCH7
<br />❑ YES 0
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office building, cons
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />22f. LOCATION OF INJURY STREET & NUMBER, APT.NO.
<br />DATE OF DEATH (Mo., Day, Yr.)
<br />Noverber29, 2025
<br />23b. ekra SIGNED (Mo., Day, Yr.)
<br />December 1. 2025
<br />CITYROWN
<br />23c. TIME OF DEATH
<br />02:58 AM
<br />23d. To the but of my knowledge, death occurred at the time, date and place
<br />and due to the cwsa(s) stated. (Signature/end Title)
<br />Jean <'NI, Meister, APRN
<br />5.t (D;Tc BAcCQ USE; CONTRIBUTE TO THE DEATH? \
<br />YES ❑ NO © PROBABLY 0 UNKNOWN
<br />27. NAME, TITLE AND ADDRESS OF CERTIFIER (Tyne or Print
<br />J:iTai)M.::;Nleistet.;APRN, 11207 W Dodge Rd, Omaha, Nebca0ka; ..; ..;
<br />28a :aegis R it'S SIGNATURE
<br />re
<br />STATE
<br />34a. DATE:SIGNED (Mo., Day, Yr.)
<br />'240. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />Ion t41te, etc (Specify)
<br />24b, TIME OF DEOff
<br />24d. TIME PReNOUI
<br />ZIP CODE
<br />ED DEAD:
<br />24e. On the hula of examination and/or investigation, In my opinion death occurred at
<br />the time, data and place and due to the cause(a) armed. (Signature end Title)
<br />•
<br />•
<br />26a. HAS ORGAN OR TISSUE: DONATION BEEN CONSIDERED?
<br />❑ YES al NO .'
<br />26b. WAS CONSENT GRANTF,O?:
<br />Not Applicable if 26a is NO
<br />2811 DATE FILED BY REGISTRAFt:SY o,
<br />December 3, 2025
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