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STATE OF NEBRASKA
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<br />WHEN THIS COPY GARRIES THE RAISED SEAL OF THE IVEBRASKA DEPARTMENT OF HEALT�-1,dNp MljMA,N;�'ERVICES, IT CERTIFIES
<br />THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD OIV FIL� WITH TH� NEB12A�l�4 �IJ�'P.Af�71N�Y1�T,DF
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSIfORY FOk i%I'�L�RC�C����S •�, t ���
<br />DATE' OF ISSUANCE '"c'''" ,�� ��
<br />_�������D� �r '? " ':�
<br />� 0110 7 41 �. �r������ .�P�� ,. �,
<br />04/11/2011 ASS���i''lfiNT�� ��ru�tt� , �
<br />D��'�7`MENT Ql� I7EAL�7-1 ANf.? ��
<br />LINCOLN, NEBRASKA HU�7ik28' �.�r° ,E�F/�CES y � ,• � �-°"
<br />� �,. ° `.•��'�� <<, • x��° ::;
<br />STATE OF NEBRASKA • DEPARTMENT OF HEALTH AND HUMAN SERVICES , �' m �•,. ,.; p q 1 01170
<br />CERTIFICATE OF DEATH : ,, ' � ? � � U� �6 'o � `. _� -
<br />I. DECEDENTS•NAME (Fi[at, Mtddle, Last, Sufftx) 2. SD( °' 3.'qATE.OF oEATd (mo.
<br />Rlchard Thomas Strickland Male Mar�h 22,`2U11 `
<br />1. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH Sa. AGE - Last Birthday b. UNDER 1 YEAR 5c. UNDER 1 DAY 8. DATE OF BIRTH (Mo.,
<br />(Yrs•) MOS. DAYS HOURS IWNS.
<br />� Hot Springs, South Dab
<br />�. SOCULL SECURITY NUMBER
<br />' 503
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<br />street and
<br />Salnt Francis Medlcal Center
<br />. CITY OR TOWN OF DEATH (Include 21p Code)
<br />Grand Island 68803
<br />Nebraska
<br />8b. COU
<br />Hall
<br />8, PART I. F�ntertha chafn M everrts-ti0seaees, MI�Ne& or comPlicadone�thet dlrectlY caused fhe death. DO NOT entar temUnal aveMS wch as cartltec arrest,
<br />�� regpiratory arr¢at, orveMricular flbtiledon wNhou[ ehowing the edology. DO NOT A88REV WTE EMar only o�re cauea on a Ibre. Atld adtltdonai Iliree H neceseary.
<br />IMMEDIATE CAUSE:
<br />,mr�owre causE c�ai e) Cardiac Arrest
<br />etaeaso wm�ton eesuttlng �
<br />10 d �� DUE TO, OR AS A CONSEQUENCE �F:
<br />s� b)TraumaticBralnlnjury
<br />anr. teamne �o ure ceuse us�tl
<br />on Iine a DUE TO, OR AS A CONSEQUENCE OF:
<br />�nlerthe UNDERLYINa CAUSE c) MOtor Vehicle Accident
<br />(disease or Ujury mat inldated
<br />tne eve�rta reeu�nrre m deasn� DUE TO, OR aS A CONSEQUENCE OF:
<br />� d)
<br />PART II.OTHER
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<br />conMbuUng to the death but nct �ultlag ta the underiying causa
<br />8d. STREET AND NUMBER . APT. NO. 8i. ZIP CODE 9g. INSIDE CITY UMITS
<br />1220 N. Custer Ave 68803 ��s ❑ No
<br />Oa. MARITAL STATUS AT TIME OF DEATH � Nlarried 0 Never Marrled 10b. NAME OF SPOUSE (Firat, NUddle, Last, Suffix) If wife, 01va rtgiden name
<br />❑ nnamea but separated ❑ vmdowea ❑ o�vorced ❑ un�cnown Nina Inez 7oml(nson
<br />1. FATHER'S-NAME (First, Middle, Last, Suff6c� 12. MOTHER'S-NAME (Flrst, Middle, Mlalden Sumame)
<br />Richard Thomas Stricktand Margaret Anna Maria Lindner
<br />13. EVER IN US. AAMED FORCES? Give dat� of service M Yes. 14a. INFORMAN7-NAME 74b. RELATIONSHIP TO DECEDENT
<br />'�res, No, or unk.� No Nina Inez Strickland Wife
<br />15. METHOD OF DISPOSITION 16a. EMBALMERSIGNATURE . 18b. LICENSE NO. 18c. DATE (Mo., Day, Yr.)
<br />� 8urlai ❑ oo�mt�on Not Embalmed March 24, 2011
<br />� Cremattort [] ErtombmecR �gd. CEMETERY, CREMATORY OR OTHER LOCA770N CITY / TOWN STATE
<br />p Removai ❑ Other (Specliy) �ntral Nebraska Crematlon Services G(bbon Nebraska
<br />17a. FUNERAL HOME MAME AND NWLING ADDRESS (Street, City or Town, State) 17b. Zip Code
<br />All Faiths Funeral Home, 2929 S. Locust Street, Grand Island, Nebraska 68801
<br />1. IF �EMALE: 21a. MANNER OF DEATH z7b. IF TRANSPVf
<br />� Not P�B�M within past year � Natural � HomlGde � Driver/Operator
<br />� PreB�mnt at tdre of deatt� � Acddent � Pentlln9lnreati8adon ❑ Pe�°9er
<br />� Not p�e9neirt, but pre9nart wtthin 42 days ot death � Su1Wde � Could �roS be detemdr�l ❑ PedeetFlan
<br />� Not PreBnant. but pregnairt 43 daYe W 1 year before death � Other (Speelh)
<br />� UNmown ii p+e9��� wfthln the Peat Year �
<br />APPROXIMATEINTERVA4
<br />or�et to aeath
<br />Minutes
<br />oriset to death
<br />2 Days
<br />or�set to death
<br />2 Days
<br />O�et to dealh
<br />T 1. 18. WAS MEDICAL EXAMINER
<br />OR CORONER CONTACTED?
<br />� YES ❑ NO
<br />a WAS AN AUTOPSY PERFORMED7
<br />Q rES ❑ No
<br />d. WERE AU70PSY FlNDINGS AVAILA
<br />TO COMPLEfE CAUSE OF DEATH7
<br />� tces ❑ No
<br />?a. DATE OF INJURY (MO., Day, Yr.) 22b. TIME pF INJURY 22c. PLACE OF INJURY•At home, fartn, etreet ��ory, oHiee butlding, consWetion site, ete. (Speetfy)
<br />March 21, 2011 12:04 PM Oklahoma Ave W. And S. Greernuich Streets
<br />2d. INJURY AT WORK? 22a DESCRIBE HOW INJURY OCCURREO
<br />❑ ves � No The decedant was driving a motorcycle, wearing a helmet, when he was struck by another car.
<br />2L LOCATION OF INJURY • STREET 8� NUM9ER, APT.NO. CITY/TOWN
<br />Intersectlon Of Oklahoma Ave & Greenwich St., Grand Island
<br />83a. DATE OF DEATH (Mo., Day, Yr.)
<br />�� � 23b. DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH
<br />�
<br />�� 0 To the beat of my browl�l9e, death oxurted at the d�, data and P��
<br />i a�w tlue to d�e eauae(s) atateu. (Slgnature a�M Ttt�e)
<br />YES � NO ❑ PROBABLY [} UNKNOWN
<br />Gail VerMaas, Hall Deputy
<br />8c. CITY OR TOWN
<br />Grand Island
<br />STATE
<br />ZIP CODE
<br />24a. DATE SIGNED (Mo., 9aY. Yr.) 2dh. TIAAE QE qE4�Tet --- _
<br />,� �� Ap�il 8, 2011 08:37 PM
<br />�� s Z 24c. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD
<br />March 22, 2011 08:37 PM
<br />$ � 24e. On the basls oi examl�mtion ar�d/or InvesGgatlon, in my opinlon Aeath occurted et
<br />� Z the tlme, daDe and place antl due to the csuse�e) atatetl. (S18nature and Titte)
<br />~ g s Gail VerMaas, Hall Deputy County Attomey
<br />� � Y E g � N O � N o t A p p l i c a b l e H 2 6 a l a N O
<br />V, Ygl G1�A T �, OR ER� SI R NTY A (Type or rint)
<br />231 S. Locust, P.O. Box 367, Grand Island, Nebraska, 68802
<br />I�_ , 28b. DATE FILED BY REOIST
<br />_ Apri111,2011
<br />61 December 29, 1949
<br />Sa. PLACE OF DEATH
<br />OSPIT � Inpatlerrt OTHER ❑ Nursi� HomeiLTC � Hoapice Facllity
<br />[] ERlOutpatient ❑ Decederrt's Home
<br />❑ DOA ❑ Other iSPe�ffY)
<br />- __ - - --
<br />8d. COUNTY OF DEATH
<br />Hall
<br />ves p No
<br />(�, �Y, Yr.)
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