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<br />`( �,,,y a11't,,,�,)�._ STATE OF NEBRASKA
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<br />WHEN MIS CDPY CARIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BE A 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 />v
<br />DATE op ISSUANCE
<br />$l'I . L024
<br />LINCOLN, NEBRASKA
<br />3sor MP
<br />202602124 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. DECEDENT'S -NAME (First, Middle, Last, Suffix)
<br />Michael Dennis ! Browning
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Minden, Nebraska
<br />7.54C14SECURITYNUMBER
<br />808-68-1:575
<br />6a<AGE • Last Birthday
<br />(Yra.)
<br />73
<br />MCILITY<NAME(If71bt Institution, give street and number)
<br />213 W 20th Street
<br />6c, CITY OR TOWN OF DEATH (Include Zip Code)
<br />hand Island 68801
<br />9a. RESIDENCE -STATE
<br />Nebraska
<br />9d.::BIRSET AND NUMBER
<br />213 W 2Oth Street
<br />9b. COUNTY
<br />Hall
<br />10a.MARITA4 STATUS.AT TIME OF DEATH ® Married ❑ Never Married
<br />❑ Married, but separated ❑ Widowed ❑ Divorced ❑ Unknown
<br />11. FATHER'S -NAME .(Find, Middle, Last, Suffix);
<br />Robert D Browning
<br />13: EVER IN Ut8. ARMEDFORCES? Give dates of service if Yes.
<br />(Yes, No, or Unk.) No
<br />16. METHOD OF DISPOSITION
<br />(] Burfal ❑ Donallon
<br />crbmatan ❑EntoRtbment
<br />Q Removil ❑ Mir (Specify)
<br />6b. UNDER 1 YEAR
<br />2. SEX
<br />Male
<br />6c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />HOURS
<br />MINS.
<br />24 03251
<br />3. DATE OF DEATH 10 play
<br />March 2, 2°24::
<br />6. DATE OF BIRTH (INo., tlay, Tr:)
<br />May 24, 1950..:,
<br />ea PEACE OF DEATH
<br />HOSPITAL ❑ Inpatient OTHER ❑ Nursing Home/LTC
<br />❑ ER/Outpatient El Decedent's Home
<br />❑ DOA ❑ Other (Specify)
<br />IBd. COUNTY OF DEATH
<br />Hall
<br />9c. CITY OR TOWN
<br />Grand Island
<br />Be. APT. NO.
<br />9f. ZIP CODE
<br />68801
<br />Sg. IPMIDECIINtUNITS•
<br />(YES, NO
<br />lob. NAME OF SPOUSE (First,Middle, Last, Suffix) If wife, give maiden names
<br />Joan Carlson
<br />14a. INFORMANT•NAME>
<br />Joan Browning
<br />16a. EMBALMER -SIGNATURE
<br />Not Embalmed
<br />12. MOTHER'S -NAME (First, Middle, Malden Surname)
<br />Ruth M Tillbury
<br />16b. UCENSE NO.
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION CITY / TOWN
<br />Central Nebraska Cremation Services Gibbon
<br />17a. FUNERAL. HOME NAME AND MA UNG ADDRESS (Street, City or Town, Stab).
<br />All Faiths Funeral :Home, 2929 S. Locust Street, Grand Island, Nebraska
<br />CAUSE OF DEATH (See IlleIrupt ofts.and examples)
<br />le. PART' I. Enter the chafe or events- diseases, Injuries, or complicatlon.4hat directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />respkatory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a HMI. Add additional lines if necessary.
<br />IMMEDIATE CAUSE:
<br />a)Metastatic bladder cancer
<br />IMMEDIATE OAU80 (Fkud
<br />rallies or cendtti.p rlauNM5
<br />M duktl
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />Sequentially list conditions, if b)
<br />any, leading to the cauN listed
<br />on: Nns a
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />agar WIDIPTLYWOCAU3Ity D)
<br />maws s et (NWT that it""ad
<br />*In even" nsuaing in death) DUE TO, OR AS A CONSEQUENCE OF:
<br />LAST d)
<br />1S. PART it .0fl ER SCGISFICANT CONDITIONS -Conditions contributing to the death but not resulting in the:underlying cause given In PART I.
<br />20. IF •FEMALE:
<br />❑: Mot /ingMint yin ttn p set yer
<br />© Preataatt►t>ira.atdeaM
<br />❑ ::Natpregflern,butprlplsntwithin 42 days of death
<br />❑ Not pregnant, but pregnant 43 days to 1 year before death
<br />❑. Unknown M pregnant wbhin the past year
<br />224.pATE OFINJURY(Mo. Day, Yr.)
<br />21a. MANNER OF DEATH
<br />® Natural ❑. Nitpick!'
<br />❑ Accident ❑ Pinang investigation
<br />❑ Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />DriverlOperator
<br />0 Passenger
<br />© Pedestrian
<br />❑ Other (Specify)
<br />14b. RELATIONSHIP TODECEDEN1":"
<br />Spouse
<br />16c. DATE (Moe, Day, Yr.),
<br />March 4 2024'
<br />Nebraska
<br />1Tb Zvi Code .....
<br />888i�'I
<br />APPROX9NATI INTERVAL
<br />assetts death
<br />4 Montht •
<br />onset to deed,
<br />onset to death
<br />19. WAS MEDIOAL EXAMINER,
<br />OR CORONEROONTACTED? '..
<br />❑ YES ® NO
<br />21c. WAS AN AUTOPSY PERFORMED?
<br />❑YES 511No
<br />21d. WERE AUTOPSYIr'1.lIDINGS AVAN.ABJA
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑ YES ❑.:NO.....
<br />22c. PLACE OF INJURY -At Horns,.farm, street, factory, office building, construction Sit.; #1g.,(tipectfjj)
<br />22d. INJURY AT WORK?
<br />❑ YES ❑ NO
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />22f 'LOCATION OF INJUR:y STREET & NUMBER, APT.NO. CITY/TOWN
<br />a
<br />I
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />March 2.2024
<br />23b. DATE SIGNED (Mo., Day, Yr.)
<br />March 4.2024
<br />23c. TIME OF DEATH
<br />11:23 AM
<br />. . Ta,id beat oragt:know edge. death occurred at the time, data and place
<br />3 eae tiff. to tin enuse(s) stated (Signature and Title)
<br />i Ryan Ramaekers, MD
<br />STATE ZIP C©DE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24b. TIME OF DEATH'
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />24d. TIME PRONOUNCED DEAD
<br />24. O.i dr. basin of illumination andlor Imeatlgadon, M my opinion dealk acdkrad at
<br />Ali.; date and place and due to the caus.(s) stated. (Signaaae gate)
<br />1
<br />26. DID TOBACCO USE CONTRIBUTE TO THE DEATH?
<br />26a. HAS ORGAN. OR
<br />❑ YES
<br />NUE DONATION BEEN CONSIDERED?
<br />gi No
<br />YES NO '❑ PROBABLY ❑ UNKNOWN
<br />27. ME, TISS AND ADD ES8 OF CERTIFIER (Type or Print
<br />`Ryan Rarttaekers, MD, 2116 W. Faidley Avenue, Grand Island, Nebraska, 68803
<br />26b. WAS CONSENT GRANTED?..:.
<br />Not Applicable If 26a is NO owe
<br />NO
<br />29a. REGISTRARS SIGNATURE
<br />tab. DATE FILED BY REGISTRAR (Mo., Day, Yr.)
<br />March 11, 2024
<br />CO
<br />Q
<br />
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