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THE FRONT OF THIS DOCUMENT IS PINK - THE BACK OF THIS DOCUMENT IS BLUE AND HAS AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW <br />ALABAMA 202001718 <br />Center for Health Statistics stata <br />ALABAMA CERTIFICATE OF DEATH Number 101 2020-08817 <br />1. DECEASED LEGAL NAME <br />Marlon Paul Gosda <br />2. DATE AND TIME OF DEATH <br />Feb 27, 2020 <br />3. ALIAS NAME(IF ANY) <br />None Given <br />4. DATE AND TIME PRONOUNCED DEAD <br />Feb 27, 2020 1045 <br />5. COUNTY OF DEATH <br />Lee <br />6. CITY, TOWN OR LOCATION OF DEATH AND ZIP CODE <br />Opelika, 36804 <br />7. PLACE OF DEATH <br />529 Lee Road 113 <br />8. SEX <br />Male <br />9. LAST NAME PRIOR TO FIRST MARRIAGE <br />10. SERVED IN <br />ARMED FORCES <br />Yes <br />11. AGE <br />65 <br />UNDER YEAR <br />UNDER DAY <br />12. DATE OF BIRTH <br />Oct 29, 1954 <br />13. BIRTHPLACE (State or Foreign Country) <br />Nebraska <br />14. SOCIAL SECURITY NUMBER <br />505-74-6175 <br />MONTHS <br />DAYS <br />HRS <br />MINS <br />15. MARITAL STATUS <br />Divorced <br />16. SURVIVING SPOUSE NAME PRIOR TO FIRST MARRIAGE <br />17. RESIDENCE STATE <br />Alabama <br />18. RESIDENCE COUNTY <br />Lee <br />19. CITY, TOWN OR LOCATION AND ZIP CODE <br />Opelika, 36804 <br />20. STREET ADDRESS <br />529 Lee Road 113 <br />21. INFORMANT NAME, RELATIONSHIP AND ADDRESS <br />Diana Renee Majors Gosda, Ex -Wife, 425 Lee Road 113, O elika, AL 36804 <br />23. FATHER/PARENT NAME PRIOR TO FIRST MARRIAGE <br />Paul F Gosda <br />23. MOTHER/PARENT NAME PRIOR TO FIRST MARRIAGE <br />Eunice K Harrell <br />24. DISPOSITION OF BODY <br />Cremation ' <br />25. CEMETERY OR CREMATORY <br />Alabama Funeral Homes <br />26. LOCATION <br />Camp Hill, Alabama <br />27. DATE OF DISPOSITION <br />Mar 3, 2020 <br />28. FUNERAL DIRECTOR <br />Joseph L Dean III <br />29. LICENSE NUMBER <br />6192 <br />30. DATE SIGNED <br />Mar 5, 2020 <br />31. FUNERAL HOME NAME AND ADDRESS <br />Frederick -Dean Funeral Home, 1801 Frederick Road, Opelika, AL 36801 <br />32. LICENSE NUMBER <br />33 <br />MEDICAL CERTIFICATION: Coroner <br />34. NAME <br />Bill Harris, Coroner <br />35. LICENSE NUMBER <br />AL43C1 <br />36. DATE SIGNED <br />Mar 11, 2020 <br />37. ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH <br />P 0 Box 2770, Opelika, Alabama 36803 <br />38. REGISTRAR <br />Nicole Henderson Rushing <br />39. DATE FILED <br />Mar 11, 2020 <br />CAUSE OF DEATH <br />40. PART <br />IMMEDIATE <br />CAUSE <br />,4 <br />84 <br />a6 <br />L DISEASES, INJURIES OR COMPLICATIONS THAT CAUSED DEATH <br />A. Gunshot to the Head and Torso <br />INTERVAL <br />Immediate <br />DUE TO (ORAS A CONSEQUENCE OF): <br />DUE TO (OR ASACONSEQUENCEOF): <br />C. <br />DUE TO (OR A CONSEQUENCE OF): <br />D. <br />41. PART IL OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH <br />42. MANNER OF DEATH <br />Suicide <br />43. PREGNANT (IF FEMALE) <br />44. AUTOPSY <br />Yes <br />45. FINDINGS <br />CONSIDERED <br />Yes <br />46. TOXICOLOGY <br />Yes <br />1 . FINDINGS <br />CONSIDERED <br />No <br />4B. TOBACCO USE <br />CONTRIBUTED TO DEATH <br />No <br />49. HOW INJURY OCCURRED <br />A e e arent self inflicted - t hots to the head and torso with a pistol I <br />50. DATE AND TIME OF INJURY <br />Unknown <br />51. INJURY AT WORK <br />No <br />52. IF TRANSPORTA E' ,^ - JJJ%Y, PBC'X t <br />, . d •J • • <br />`��� - --I <br />53. PLACE OF INJURY <br />Home <br />54. LOCATION OF INJURY ka • • <br />529 Lee Road 113, Opelika, , <br />ti e <br />This is an official certified copy of the original recor4AYgd-in th <br />Statistics, Alabama Department of Public Health, Montgomib' Imbese'l <br />March 11, 2020 <br />ADPH HS E1/REV 01-16 <br />r w.5 <br />• pf <br />fuer.. of Health <br />Q193.'713-0 <br />Nicole Hen rson Rushing <br />State Registrar of Vital Statistics <br />ILVI IsIila..IPJCINAVIBil[a r1MLWM <br />