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<br />STATE OF-NEbRASKA _ _ )
<br />Arsryinlnl,141\ \le';
<br />�y(1111y�1111110 r ? rlrllnkli!41i�1111�44ii►\•
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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 OFTHE 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 />'DATED PISSUANOE
<br />2/25/2026
<br />LINCOL.N, NEBRASKA
<br />2026019
<br />ta
<br />SARAH BOHNENKAMP
<br />ASSISTANT STATE 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 DEOEDENNT> tilt: (Fk t Middle, Last, Suffix)
<br />George Marian Morris
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Bet�irade, Nebraska
<br />T. SO:CIAL SECURETY>NUN!ER
<br />508=50-9281`
<br />5a. AGE - Last Birthday
<br />83
<br />lb. FACIUTY-NAME (If not Institution, give street and number)
<br />412`Campbsll Ave ...;::
<br />rlc 6t'tff ORTONN OFDam (Include Zip Code)
<br />Doniphan 68832
<br />9.. RESIDENCE -STATE
<br />Nebraska
<br />6d. $TREETANONIJHEER
<br />412':Campb'ell Ave
<br />9b.000NTY
<br />Adams
<br />10a. MARITAL STATUS AT TIME OF DEATH ® Married ❑ Never Married
<br />[] IYgFtSd, buteepl $ted ❑ Widowed ❑ Divorced ❑ Unknown
<br />11 FATTHER'S-NAME first,;;' Middle, Last, Suffix)
<br />Oscar Morris
<br />18. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or Link.) No .
<br />13 METO0OF:DI8PO )11ON
<br />0 urtef O DDon.ua►
<br />catenation '[ ] Entombment
<br />❑Removal ❑ Other (Specify)
<br />6b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />6c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL 0 Inpatient
<br />❑ ER/Outpatient
<br />DOA
<br />9c. CITY OR TOWN
<br />Doniphan
<br />HOURS
<br />MINS.
<br />OTHER ❑ Nursing Home/LTC
<br />® Decedent's Home
<br />0 Other (Specify)
<br />8d. COUNTY OF DEATH
<br />Adams
<br />Bs. APT. NO.
<br />9f. ZIP CODE
<br />68832
<br />3. DATE OF DEATH(Mo.,
<br />February 6,
<br />8. DATE OF BIRTH (Ma., Day, Yr.)
<br />October 31 .1942
<br />C7 Naltay
<br />ElAsas
<br />'O IN$IDe CITY L
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) If wife, give maiden none
<br />Margaret Ellen Johnson
<br />12. MOTHER'S -NAME (First, Middle, Malden Summate)
<br />Louise " Naeve
<br />14a. INFORMANT -NAME
<br />Margaret Ellen Morris
<br />His. FUNERAL DIRECTOR SIGNATURE
<br />Katie M. Smydra
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />111. FUNERAL NOM E NAME:iAND MAIUNG ADDRESS (Street, City or Town, State)
<br />A8 Faiths FUtMri tome, 2929 S. Locust Street, Grand Island, Nebraska
<br />16b. LICENSE NO.
<br />1454
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examoles)
<br />1s PART). Enter the MINN of aveni- ninon, injuries, or compllcationsahat directly caused the death. DO NOT enter terminal events such as cardiac sweat,
<br />Nap st4tft amlat der Vefl eider fibrillation without showing the etiology. 00 NOT ABBREVIATE. Enter Only one Men on a Men Add additions( lines I naeeswy.
<br />IMMEDIATE CAUSE:
<br />ITiIc*USEOita a) Acute on chronic diastolic congestive heart failure
<br />orldkWlrrenni.
<br />N death)
<br />lint can gerrW8
<br />Vtlay,IXWIIMMIO lhs,auutt :nypd
<br />A Inter the UNDERLYING CAUSE
<br />O (disease orbItnYEnd Innate"
<br />the event* teeuaing M dent):.
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />b)Atherosclerotic cardiovascular disease
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />C)
<br />14b. RELATIONSHIP TO DECEDENT
<br />lea DAT! (Mar. DI 3iYr ),; }'
<br />February 164626 `.
<br />STATE
<br />1
<br />APPROXIMAIMtNTERWIL
<br />•
<br />onset tai45). i
<br />4 Monttl
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />16. PART fr OTHER SIGNIFICANT CONDITIONS-Condltlons contributing to the death but not resulting In the underlying cause given In P
<br />Sick sinus syndrome, chronic atrial fibrillation, chronic obstructive pulmonary disease, hypertension, vascular dementia
<br />aeIF MAa
<br />•
<br />o MO.lPnl9aantw9.lnpNbt .:
<br />❑ t*aaa a tkesof death
<br />❑ Net pregnant, but pregnant eath8 a days of death
<br />regn NietPam, bid. prylnrtt.47 days to 1 your before death
<br />m #
<br />0 Ontri pretend eitlhkrtM past year
<br />22.. DATE Of INJURY (MO:;;:Day, Yr.)
<br />II
<br />wer i22f LOCATION OF INJURY :STREET & NUMBER APT.NO.
<br />23a. DATE OF MATH (Mo., Day, Yr.)
<br />February. 6, 2026
<br />22d. INJURY AT WORK?
<br />i yfB I NO
<br />2.2k DATA TIONED.: Y 0., Day, Yr.)
<br />February 10 2028
<br />21e. MANNER OF DEATH
<br />ElNatural 0 Homicide
<br />0 Accident 0 Pending investigation
<br />determined❑ Suicide 0 Could not be determined
<br />22b. TIME OF INJURY
<br />21b, IF TRANSPORTATION INJURY
<br />0 Dnwrlopeneor
<br />0 Passenger
<br />0 Pedestrian
<br />0 Other (specify)
<br />meat b:
<br />ART L
<br />19. WAS MEDICJItiMAMINIR
<br />OR CORONER CONTACTED?
<br />❑ Tee N0:
<br />21c. WAS AN AUTOPSY•PR JR*JED :'
<br />❑ YES El NO
<br />21d. WERE AUTOPSY FINON1a$AVAR,ASU
<br />TO COMPLETI CI, USE OI!;;DE/47158.:,.
<br />❑ YES I]
<br />22c. PLACE OF INJURY•AIhome, farm, street, factory, office building, construction sits, see.:
<br />aus. DESCRIBE HOW INJURY OCCURRED
<br />CITY/TOWN
<br />23c. TIME OF DEATH
<br />02:30 PM
<br />n .To tet tenet pE it.Y Nmownies, death occurred at Me time, date and place
<br />and* to the ause(s) aimed. (signature and Tote)
<br />Steven Husen, MD
<br />Rdr�tTT0�0.13CQ(4Ii
<br />.1`ONTSIBUTE TO THE DEATH?
<br />AMIABLY 0 UNKNOWN
<br />NAME; ME AND ADDRESS OF CERTIFIER (Type or Print
<br />Steven Husen, MD, 2116 W Faidley #400, Box 9802, Grand Island, Nebraska, 68803
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24b. TINE OF Dril
<br />24d.11ME PRONOUN
<br />2M. On the Crisis of examination and/or Investigation, N my opinion deader ...
<br />the time, date and piece and due to the ceuaua) stated (signature and
<br />28a. HAS ORGAN OR - t NATION BEEN CONSIDERED?
<br />❑ YES 14 NO
<br />26b. WAS CONSENT GR
<br />Not Applicable If 29a is NO
<br />
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