|
.........................................
<br />1 rW/%/Illrl r1r114 �t!4" "'. r r
<br />u1111Ntu• '...., lnrrrini� +�//lll'11111ND`c• /nyr/1r`> �/1711111iW11` •: rrrrryr, rr,
<br />.,, ���11111111111iii? iu.rrl�C�)(iii�lilrlrl!l (ter>�.�,: ���1111111111%7 i� ' .�ri� `fill/���iiiirlliyrryUii ���i�'1/�'Iri�l�/�r r U11,�„�f,
<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRI€S THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW TO
<br />BEA TRUE COPY'OFTilt ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICWIS THE LEGAL DEPOSITORS' FOR VITAL RECORDS
<br />DATE OF ISSUANCE
<br />5/20/2026 -
<br />LINCOLN, NEBRASKA
<br />202603'428 3,04d1 ,, ,,ht.
<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 />4 oeceterrelIAME oust.' Middle, Last, Suffix)
<br />ShirlOV Ann Freeman /
<br />4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH
<br />Omaha, .Nebraska
<br />T I AL:SECURITY:NUMBER
<br />505-56429t
<br />6a. AGE - Last Birthday
<br />(Yrs-)
<br />81
<br />lib. FACIUTY-NAME (if not Institution, give street and number)
<br />Tiffany Square Cate Center
<br />Sc. CITY OR TOWN OF DEATH (Includ.Zip Code)
<br />Grand island 68803
<br />9t RESIDENCE -STATE
<br />Nebraska
<br />W. STREET AND NUMBER
<br />2122 W 16th Street
<br />fib. COUNTY
<br />Hall .,
<br />10s. MARITAL STATUS AT TIME OF DEATH ® Married 0 Never Married
<br />Q Marled, but eaparated ❑ Widowed 0 Divorced ❑ Unknown
<br />1t FATHER'S -NAME (First,:; Middle, Laiit, Suffix)
<br />Wiliam H Schuette
<br />13. EVER IN U.S. ARMED FORCES?
<br />(Yes, No, or unit.) No
<br />IS ,4011OD;OFOISPOSI' ON
<br />Burial d Donation:
<br />Q Epromadart ID Entmrrbment
<br />❑ Removal ❑ Other ( y)/
<br />Ob. UNDER 1 YEAR
<br />2. SEX
<br />Female
<br />Sc. UNDER 1 DAY
<br />MOS,
<br />DAYS
<br />8a. PLA E OF DEATH
<br />HOSATAL 0 inpatient
<br />❑ ER/Outpatient
<br />❑ DOA
<br />9c. CITY OR TOWN
<br />Grand Island
<br />HOURS
<br />MINS.
<br />3. DATE OF DEAT
<br />May 8, 2026
<br />6. DATE OF BIM (Mo., Day, Yr
<br />January 18i i9145'
<br />OTHER ® Nung Home/LTC
<br />\ ❑ Decedent's Home
<br />❑ Othe►(SWify)
<br />8d. COUNTY OF DEATH
<br />Hall
<br />M. APT. NO.
<br />Of. ZIP CODE
<br />68803
<br />Q Hoeplca Facility
<br />ycE,s
<br />ig..insisa CITY UNITS
<br />C7No
<br />10b. NAME OF SPOUSE (First, Middle, Last, Suffix) I wife, give maiden nave
<br />Billy Dale Freeman
<br />14a. INFORMANT -NAME
<br />Billy Dale Freeman
<br />ISa. FUNERAL DIRECTOR SIGNATURE
<br />Laurie D. Sheffield
<br />12. MOTHER'S -NAME (First, Middle, Malden Surname)
<br />Lenora Schultz
<br />16d. CEMETERY, CREMATORY OR OTHER LOCATION
<br />Chapman Cemetery
<br />1Ta. FUNERAL NOME NAME.AND MAIUNO ADDRESS (Street, City or?bwn, State)
<br />Ail' Faiths Funeral Rome, 2929 S. Locust Street, Grand Island, Nebraska
<br />18b. LICENSE NO.
<br />1397
<br />CITY / TOWN
<br />Chapman
<br />CAUSE OF DEATH (See Instructions and examples)
<br />Is. PART L tkaa the Main of,vase- -diseases, injuries, or complicationMMt directly caused the death. DO NOT enter terminal events such as cardiac arrest,
<br />respkrae y arrest, or 410'40 user IWdWlon without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary.
<br />IMMEDIATE CAUSE:
<br />ttlttEATt:CAUSE (mist II) End -Stage vascular dementia
<br />daartzaa.olraNionrestdtilfp
<br />In del DUE TO, OR AS A CONSEQUENCE OF:
<br />atwue.I ralaacn '1t: ;: b)Cerebrovascularaccident
<br />#dy:U.ridlrgla et►C>llae p*M4•
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />Enter tie uNDSRLVINS CAUSE c) Atrial fibrillation
<br />Wane er inb+n that Initiated
<br />are events resulting N *Wig .DUE TO, OR AS.A CONSEQUENCE OF:
<br />txsT .. d)
<br />ill. PART L ONER SIGNIFICANT CONDITIONS -Conditions contributing to the death but not resulting in the underlying cause given in PART I.
<br />Atrial fibrillation, hypertension, hyperlipidemia, ulcerative colitis, appendiceal mucocele, hip fracture
<br />S�IF.,I=BIVIALE :::
<br />Q Slit pri rtrriddr[ pset year:
<br />(] f liltppUs at lase of 0000.::'
<br />❑ Not pngmnt, but
<br />prsgeant within 42 days of death
<br />lea pregnant, ew pregnant. days to 1 yea baton death
<br />#biknawn if pwpmnt wtell the pest yea
<br />Eta. D A, OF INJURY (Moth Day, Yr.)
<br />22d. INJURY AT WORK?
<br />OYES. ONO
<br />21a. MANNER OF DEATH__
<br />Ea Natural ❑ Homicide
<br />❑ Accident ❑ Pending investigation
<br />❑ Suicide ❑ could not be determined
<br />22b. TIME OF INJURY
<br />21b. IF TRANSPORTATION INJURY
<br />❑ Driverdoperator
<br />❑ Passenger
<br />❑ Pedestrian
<br />❑ Other (Specify)
<br />14b. RELATIONSHIP TO DECEDENT
<br />Spouse ..
<br />16a DATE (MO;BI
<br />May 14, 2026
<br />,Ift:):
<br />STATE
<br />Nebraska
<br />' APPROXIMATE INTERVAL
<br />onset to death
<br />3 Years '..
<br />onset to
<br />5 Years
<br />19. WAS MEDIGAii IXAMINEA '
<br />OR CORONER CONTACTED?
<br />® YES D No
<br />21c. WAS AN AUTOPSY PERFORMED?;
<br />❑ YES } tO
<br />21d. WERE AUTOPSY FINDINGS AVAILABLE
<br />TO COMPLETE CAUSE OP DEATH?
<br />❑ YES ❑ NO
<br />22c. PLACE OF INJURY -At home, farm, street, factory, office buliding, construction
<br />22e. DESCRIBE HOW INJURY OCCURRED
<br />22f LOCATION OFINJURY STREET&NUMBER, APT.NO. CITY/TOWN
<br />23a. DATE OF DEATH (Mo., Day, Yr.)
<br />May,8,2026
<br />23b. DATE SIGNffiI (Mo., Day, Yr.)
<br />Mav 8 2026.
<br />---23c. TIME OF DEATH
<br />12:40 AM
<br />23d. To dirt beatelmyt howledge, death occurred at Ste One, date and place
<br />and due to Me cause(e) staled. (Signature and Title)
<br />Krista M Stoecker, MD
<br />STA1
<br />24a. DATE SIGNED (Mo., Day, Yr.)
<br />24c. PRONOUNCED DEAD (Mo., Day, Yr.)
<br />•
<br />24b. TIME OF DEATH
<br />Md. TIME PRONOUNCED DEAD w i
<br />24e. On the basis or examination andlor investigation, In my opinion death
<br />wOticut sg at
<br />the tine, date and place and due to the ese(s) stated. (6ignatus and a11N)
<br />Di> 'TOBACCp USS.DONTE BUT! TO THE DEATH? 28a.'HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED?
<br />I ❑ YES 10 NO
<br />2?. NAND, TrtLEA. ND ADDRESS OF CERTIFIER (Type or Print
<br />Krista M Stoecker, MD, 3563, Grand Island, Nebraska, 68803
<br />2
<br />YES Nlio PROBABLY 0 UNKNOWN
<br />26b. WAS CONSENT GRANTD?,
<br />Not Applicable If 26a Is NO
<br />26b. DATE FILED BY REGISTRAR:t(
<br />May 18, 2026
<br />YES
<br />o.,!)ay,
<br />
|