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<br />1t41 ; rtrr " nat_rrSTATE OFVEBRASKA
<br />WHEN nOtt COPYCARRRIES THE RAISED SEAL OF STATE OF NEBRASKA, !'I' CERTIFIES THE DOCUMENT BELOW TO
<br />BE A: RUE 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 />N
<br />DATE OF+SSu
<br />4/29/2026 :.
<br />LINCOLN, NEBRASKA -
<br />2026027 91 jouiSARA` A 180?
<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 />itDEI ERrSiNAME!!:IPita(}:; Middle, Last, Suffix)
<br />Dawn.......rene :::F9n1s
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />City( ILkN►a `;
<br />T: 0 tl SECURn-i NUMBER
<br />4834tt 921'8::
<br />6a. AGE - Last Birthday
<br />(YrL)
<br />74
<br />/
<br />db. FACILITY-NAME(If not Institution, give street and number)
<br />3024:Idah4' t$.
<br />lie CITY OR 70,,t o : P kr (Include Zip Code)
<br />Grand Island 6G3'
<br />941. RESIDENCE -STATE
<br />€<era Ice
<br />Sid STREET;ANDN7MBErR<`;
<br />6b.COUNTY
<br />\ Hall
<br />10e. MARITAL STATUS ATTIRE OF DEATH ® Married ❑ Never Married
<br />0 Marred, but separated ❑ Widowed ❑ Divorced ❑ Unknown
<br />1i FAtt1ER&NirME (First .:t Middhs. Last, Suffix)
<br />Willia�rra;;:Leroy ;€#pie settine/
<br />13. EVERSi U.S. ARMED FORCES?
<br />(Yes, No, or Unk.) No
<br />4lS.ME13itifr F l$POSITION
<br />Aire" ei4sianime
<br />0 R al ['Other (Specify)
<br />6b. UNDER 1 YEAR
<br />2. SEX
<br />Female
<br />6c. UNDER 1 DAY
<br />MOS.
<br />DAYS
<br />8a. PLACE OF DEATH
<br />HOSPITAL ❑ inpatient
<br />❑ ER/Outpatient
<br />❑ DOA
<br />Sc. CITY OR TOWN
<br />.Grand'Island
<br />HOURS
<br />MINS.
<br />3. DATE OP 0EAT#
<br />Found April 1`
<br />6. DATE OF SIRTN (Ma, Day, Yr.)
<br />OTHER ❑ Nursing HanNL,,TC
<br />November fl4 ,1961
<br />CI tiOlpio•Ve
<br />® Decedent's Home
<br />❑ Other (Specify)
<br />ed. COUNTY OF DEATH
<br />Hall
<br />9e: APT. NO.
<br />Sf. ZIP CODE
<br />68803
<br />10b. NAME OF SPOUSE (Spot, Middle, Last, Suffix) If wife, give maiden noose
<br />Joseph Patrick Ferris
<br />12 MOTHER'S -NAME (First, Middle, Maiden Summit)
<br />Mary Ellen Hamilton
<br />14a. INFORMANT -NAME
<br />Joseph Patrick Ferris
<br />111a. FUNERAL DIRECTOR SIGNATURE
<br />Caleb/J Alcorta
<br />led. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Central Nebraska Cremation Services
<br />1Ft Futiervit, M MME ti0014. sD MAIUNG ADDRESS (Street, City or Town, State)
<br />< 11 Fair Fiunerat io' tee, 2929 S. Locust Street, Grand Island, Nebraska
<br />16b. LICENSE NO.
<br />1607
<br />CITY / TOWN
<br />Gibbon
<br />CAUSE OF DEATH (See instructions and examples)
<br />it ►AR`rL inter the chain of events- dtaeeass, injuries, or complications4hat directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />msp rotary arnet,.or v stmcidarfhrlYMbn without showing the etiology. DO NOT ABBREVIATE. Enter only one cams one line. Add additional lines if necessary.
<br />:;IMMEDIATE CAUSE:
<br />''"4) Unknown Natural Causes
<br />rci! CAUSE
<br />RAf:.¢Q'eilala:rw
<br />M Neel
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />AqusnpeNarIleteaMoa„N;;.. b►Pneumonia
<br />4.0.10.440011*.* N Nairn
<br />... . .. :..... :<;:DUE TO, OR AS A CONSEQUENCE OF:
<br />tour tlY ' 6R Y NGCAt c►High Blood Pressure
<br />(diesels or Injury that initiated
<br />the wont* resulting in death) DUE TO, OR AS A CONSEQUENCE OF:
<br />d)
<br />T
<br />61911. PARTI4137HEISSIGKIFISANT CONDITIONS -Conditions contributing to the death but not resulting in tee
<br />M IF FEMJ
<br />INbf progley* W Itlln $at year
<br />0 goon tilt lime o deat . :
<br />0 Not program, but pregnant WOW 42 days of Math
<br />Q Not pregnan. but Pregnant 43 days to 1 year before death
<br />>❑ Unknown Ifpregnan w11=1*1MWs►yea'
<br />q� DATEGF 14.uft iMii. DiY.Yr.)
<br />22d. INJURY AT WORK?
<br />21a. MANNER OF DEATH
<br />® Natural ❑Hof W&
<br />❑ Accident 0 Pending investigation
<br />0 Suicide ❑ Could not be determined
<br />22b. TIME OF INJURY
<br />denying cause given in PART I.
<br />21b. IF TRANSPORTATION INJURY
<br />❑ illorn/Cperator
<br />• ❑ Passenger
<br />❑ PePedestrian❑ Other (Specify)
<br />onset to,
<br />WAS
<br />CORONER Omer*
<br />® YES ❑ NO
<br />iti'
<br />21c, WAS AN AUTOPSY;PERPC
<br />❑ YES ®NQ
<br />21d. WERE AUTOPSY FINDINGS AVAILANLLt
<br />TO COMPLETE CAUSE OF DEATH?
<br />❑YES OtI
<br />22c. PLACE OF INJURY -At home, Uri*street, factory, ¶11ce building, construction Site, a1g {
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />.M 2sr LOP: rATio!N OF IN.RIRY :STREET i NUMBER, APT.NO.
<br />9
<br />tl„
<br />t
<br />'
<br />• al
<br />23s. DATE OF DEATH (Mo., Day, Yr.)
<br />CITY/TOWN
<br />311.DA''l`loSIi D;(Mo., Day, Yr.)
<br />23c. TIME OF DEATH
<br />23i;141IMBest otfy:bmwledge, death occurred at the time, data and place
<br />.. > and diw atii'i.tlivaela) stated (Signmtae and Title)
<br />DIp TCEXCCO USE CF'S/1TltIBUTE TO THE DEATH?
<br />[ .:YEs.,,,.; [ .tt10:, JPROBABLY ® UNKNOWN
<br />117. NAME 1tTLE4ND ADDRESS OF CERTIFIER (Type or Print
<br />Kylen Curry, Hall County Deputy Attorney, 231 S Locust St, Granclebraska, 68801
<br />26a. HAS ORGAN OR
<br />1 ❑ YES
<br />STATE
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />April 17, 2026
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />April 16.2026
<br />24b. TIME OF DEATH
<br />Approx. 04;25 AM
<br />24d. TIME PRONOUNCED.
<br />04:25 AM
<br />24e, On the biota of examination endlor Investigation, in my opinion Oath dt(Gflti i
<br />the tin*, date and place and due to the covets) stated. (signahae aid 11100
<br />Kylen Curry, Hall County Deputy Attorney
<br />TISSue DO ATLON`BEEN CONSIDERED?
<br />El NO
<br />. REG STRAFt11.S GNATURE
<br />!tl/d4-%KT�-
<br />26b. WAS CONSENT GRANTS)1
<br />Not Applicable If 2110 Is NO YsRi
<br />26b. DATE FILED BY REGISTRAR(MW.. idly,
<br />Aprit 23, 2026
<br />
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