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STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, lT CERTIFIES THE BELOW TO BE A TRUE CDPY OF THE OFtIG/NAL R,ECDRD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH /S
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE ..~~
<br />' ~I t""'(1 , ,
<br />FEB d ~ 2008 T~~~~:P~~
<br />LINCOLN, NEBRASKA 2 p i p 4 5 91'7 HEALTFI~I~T .g MAN~dC~
<br />:r .+~+' r~ ~ ~: .r '
<br />. l
<br />STATE OFNEBRASKA- DEPARTMENT OFHEAL-TH AND WUMAN SERVICES FIMANC~E AN~U ~" _~
<br />CERTIFICATE ~F DEATH O ~ 7 2
<br />
<br />t.OECEDENT'5-NAME (First, Middle, Last, Suffix) 2.5F.1~ ~'.c~" ryu ,y~a~T~~FD'E9TH (Mo.,Day,Yr.)
<br />Edward Joseph Bigley Idal~i; ' ~' . ua~y 28, z0o9
<br />4. CITY AND STATE pR TERRITORY, OR FOREIGN COUNTRY pF BtgTH 5a. AGE•Laet Birthday 5b. UNDER 1 YEAR Sc. UNDER 1 4AYW ~~~ 8[ DAT~ OF BIRTH (Mo., Dey, Yr.) ~I
<br /> (Yrs.) MOS. DAYS HOURS MIN3.
<br />Greeley, Nebraska 9D February 11,1917
<br />7.50CIALSECURITVNUMBER Ba.PLACEpFDEATH
<br />520-~9-178 IiOSPJ.TA.L: ^ Inpgtlent 4IHEB ~NUraingli0me/LTC ^HospiceFaclllty
<br />84. FACILITY•NAME (11 net Instllullon, give etraet and number) ~ ~ ~- - -~'~
<br />^ ERlOulpatlent ^ DeCedeM'6 Home
<br />Nebraska Veterans Home
<br /> ^ ~ ^other(Speclty)
<br />BaCITYORTOWNOFDEATH (IncludeZlpCode) Bd.000NTYOFDEATH
<br />Grand Island, 688p3 Ha11
<br />9a. RESIDENCE-STATE 96. COUNTY Bc. CITY OR TOWN
<br />Nebraska Hall Grand Island
<br />9d.S7REk7ANpNUMBER 9e. APT. NO eT.ZIPCOgE eg.IN51pECITYLIMITS
<br />1003 L. Bismark 6@8Q1 ~[ YES ^ No
<br />10a. MARITAL STATUS AT TIME OF DEATH Married ^ Never Married 10b. NAME OF SPOUSE (First, Middl6, Last, Suffix) I1 wile, give maiden namn.
<br />^ Mewled, but separatetl ^ Wltlowed Q bivarced ^ Unknown Irene Farlee
<br />11. FATMER'S•NAME (Ffrat, Middle, Laat, Sutflx) 12. MOTHER'S-NAME (First, Middle, Malden Surname)
<br />Joseph T. Bigley Catherine Kinney
<br />13. EVER IN U.S. ARMED FORCES? Glve dates of se vice If yes.
<br />fan 27
<br />194 14a. INFpRMANT--NAME 14b. RELATIONSHIP TO DECEDENT
<br />,
<br />(Yes,nd,orunk,) 7fas Oct 31, 1945 Irene Bigley Wife
<br />15. METHOD OF DISPOSITION ,., t8a'E ~ ER•SIDNATURE ,.~~'"
<br />~ 18b. LICENSE N0. 1 Bo. DATE (Mo., Day, Yr. )
<br />~Buriel ^DoneBon ~
<br />~~ 192 Feb 1, 2008
<br />^ Cremptlon ^ Entombment t8d. CEMETERY, CREMATORY OR OTWER LOCATION CITY /TOWN STATE
<br />© Ramavel ^ Other (Specify) Westlawn MemOrlal Park Cemetery
<br />17a. FUNERAL HOME NAME AND MAILING ADDRESS (Street, City or Town,.Slele) 176. Zip Code
<br />Curran Funeral Chapol 3005 South LOiCUSt Street Grand Island, NE 6$801
<br />16. PART I. Enter the chain of events--diseases, InJurlea, or compllcationa--that directly caused the death. DO NpT enter terminal avante such as caMlec arrest, APPROXIMATE INTERVAL
<br />I
<br />respiratory arreah or ventricular flbrlllatlon wlthaut showing the 811olpgy, DO NOT ABBREVIATE. Enter only one Cause on a line. Add addltlonal Ilnes II necessary. ~
<br />IMMEDIATE CAUSE: I coast to death
<br />i
<br />I
<br />IMMEDBITECAUSE(Fkul (a) Dementia Alixed T e ~ 1 Year
<br />dlMaeeacondltlanreauldng OUETO,ORAgACONSEOUENCEOF: I anaettodeath
<br />N death)
<br />I
<br />$equentlellylletcondltlone,N (bl Dysphagia ' ~ 1 Year
<br />I
<br />any,badlrtgtotheauaelLvtad'pUETO,ORASACON5EQUENCEOF: I onset todeatn
<br />on Ilne a.
<br />ErllertrMIX4DERLY9UGCAl15E '
<br />(dlaeaeearlnJurymattnluapd (~) Aspiration Pneumonia 2 Months
<br />theevsmsresulting In death) , qUE T0, OR AS A CONSEQUENCE OF; I onset tc death
<br />LA6T
<br />I
<br />(~ I
<br />18. PART IL OTHER SIpNIFICANT CONpITION5•Candltlona contributing le the death but not raeulting In the underlying cause given in PART I. 19. WAS MEDICAL EXAMINER
<br />CVA, Diabetes Mellitus II, CAD. OR CORONERCONTACTEp7
<br />^ YE5 ~ NO
<br />20. IF FEMALE: 21a.MANNEROFDEATH 2i b. IFTRANSPORTATIONINJURY 21C.WASANAl170PSYPERFpRMEDT
<br />^ Notpregnaniwithinpastyear ]~Nfltural ^Homlclde ^prWerlOparator
<br />^ YES ~NO
<br />^ Pregnant et gme o1 death ^ Accldent^ Pending Inveatigatlon ^ Passenger
<br />^ Pedestilen
<br />^ Nol pregnant, but pregnant within 42 days at death ^ guiclde ^ CouW oat be determined 21d. WEREAUTOPSY FINDINGS AVAILA%ETO
<br />^ Nol re Want, but r Want 43 de s tc 1 ear bafare tleetn ^ Ofher (Specify)
<br />P 9 peg Y Y COMPLE7ECAU5EOFDEATH7
<br />Q Unknown i} pregnant within fhe peat year ^YE5 ^ NO
<br />cn r _ -- .. _.__.. ..
<br />-=2~~-F~''~ (~~Y~~~•r ---- ~=*~E:.fJ3Jdiiiif - - ~f=2~i~biu'e Ofr-t1iJUitrwrli trmne; 48rm,-etreat; rectory; 8>TCa-DOgdm(~ Eonstruc[ton aiia, std. (Specl(y)
<br />m
<br />22d.INJURYATWORK7 22a.gE5CRIBEHOWINJURY000URRED
<br />^ YES [] Np
<br />22f. LOCATION OF INJURY • STREET S NUMBER, APT N0. Cfl'Y/rOWN ~ STATE ZIP CODE
<br />
<br />~ 23a. DATE OF DEATH (Mo., Dey, Yr.) } 24a. DATE SIGNED (Mo., Day, Yr.) 244.TIME OF DEATH
<br />~' January 28, 2008 g ~ m
<br /> 236. DATE 51GNEp (Mo., Day, Yr.) 23c.TIME OF DEATH ~ ~ 24c. PRONOUNCED DEAD (Mo., Dey, Yr.) 24d, TIME PRONOUNCED DFJ1D
<br />~~o January 30, 2008 5:30 P.m aaa~
<br />~ m
<br />v
<br />~ 23d.TO the best of my knowledge, death occurred at the time, date end place
<br />and due to the cause(s) stated. (Signature and Title) - ~ ~ ~
<br />24e. On the basis of examination and/or Inveatigatlon, in my opinion death occurred at
<br />~ c ~ the time
<br />date and place and due to the cauae(6) elated
<br />(Signature and Title)
<br />~
<br />0
<br />y ,
<br />.
<br /> m Pr ~ s ~
<br />25, bIbTOt3ACC0 USE CONTRIBUTETOTHEgEATH? 28a. HAS ORGAN OR TISSUE DONATION BEEN CONSIpEREp? 266. WA$ CONSENT GRANTEp7
<br />_ ^ YES ~ NO ^ PROBABLY ^ UNKNOWN ^ YES ~ NO Nc1 Applicable if 28a Ie NO ^YE5 ~[ NO
<br />27, NAME, TITLE AND ADDRE53 OF CERTIFIER (PHYSICIAN, CORONER'S PHYSICIAN OR COUNTYATTORNEY) (Type or Print)
<br />Jenn2fier King, M.D., Grand island Veterans Home, Grand Island, NF. 68803
<br />28a. REGISTRAR'S SIGNATURE I 286. DATE FILEO BY REGISTRAR (Mo., Dey, Yr.)
<br />~'X~! • ,0 • FEB 4 20U8
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