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STATE OF. IOWA <br />IOWADEPARTMENT OF PUBLIC HEALTH <br />CERTIFICATE of DEATH <br />DECEDENT INFORMATION <br />NAME: Justin Dennis Cordon Gaunt <br />ALIAS: <br />PLACE OF BIRTH: Washington <br />ARMED FORCES: No <br />DECEDENT MAIDEN LAST NAME:Gaunt <br />FATHER'S NAME:(prior to;aay marriage) Darwin Young .' <br />MOTHER'S NAME:(priorteany marriage) Barbara Anderson , ...., <br />RESIDENTIALADDRESS:2931 Roselawn Dr. <br />Grand Island, Nebraska 68801 <br />INFORMANT NAME:.Cassie Gaunt <br />INFORMANT RELA'T'IONSHIP: Wife <br />MARITAL STATUS: Married <br />SURVIVING SPOUSE :(prior to any marriage) Cassie Tenski <br />MEDICAL CAUSE OF DEATH INFORMATION <br />DATE FILED: 06/23/2021 <br />SSN: 562-354899 <br />SEX.: Male <br />DATE OF BIRTH/AGE: 08/28/1973 47 Years <br />DATE/TIME OF DEATH:05/10/2021 (Actual) <br />08:40 PM (Actual) <br />RESIDENCE COUNTY: Hall <br />0.OU NTY OF DEATH: Polk <br />PLACE OF DEATH: Inpatient <br />FACILITY/ADDRESS: UnityPoint Health -Iowa Methodist Medi <br />-Denter--Des Moines <br />Des Moines,'Iowa 50309 <br />IMMEDIATE CAUSE OF DEATH:. Probable Atherosclerotic Cardiavascular;Disse <br />DUE TO OR A CONSEQUENCE OF: <br />DUE TO OR AS A CONSEQUENCE OF: <br />UNDERLYLNG CAUSE, IFANY <br />OTHER SIGNIFICANT CONDITIONS: <br />INTERVAL UNITS <br />Years <br />MANNER QF DEATH:. > Natural:.. <br />AUTOPSY PERFORMED/FINDINGS;' <br />TOBACCO CONTRIBUTED TO DEATH:Unknown <br />M <br />.E. CONTACTED: Yes ME CASE #:21-1174 <br />METHOD OF DISPOSITJON: Cremation <br />PLACE: Caldwell Parish Crematory -Urbandale <br />LOCATION: Urbandale, Iowa <br />FUNERAL DIRECTOR: Sweerin, Amanda Jo <br />Caldwell Parrish Funeral Home and Crematory -Urbandale <br />Urbandale, Iowa 50322 <br />CERTIFIERITITLE.:Joshua 'William Akers MD <br />DATE::: CERTIFIED: 06/23/2021 <br />CERTIFIER ADDRESS:1801 Hickman Rd <br />Des Moines, Iowa 50314 <br />is is to certify that this is a true and correct reproduction of the original record as recorded in this:; state issued under the authority of Chapter 144, Code of Iowa. <br />This copy is not.valid unless prepared on c.• -graved border displaying state seal and signature of the Registrar or Designee. <br />THIS COPY NOT VALIDUNLESS UNALTERED AND PREPARED ON. CERTIFIED SECURITY PAPER <br />DATE ISSUED COUNTY REGISTRAR <br />1111111I�IVI(�IT""�"" poll( <br />FORM #58$ {132$$ (Revised 09r2017) <br />. 'Atf`' • "AUAY4YM�iM "w MAlWE};ti1AM4 cL4uaA <br />"' ✓ k ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE r '�; <br />'� .._ <br />