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gA-0A,.S ^ <br />u%y <br />FACT OF DEATH NUMBER STATE FILE NUMBER <br />23 140 -2017- 000014 <br />DECEDENT'S INFORMATION; DATE FILED: 01/06/2017 <br />NAME: OSCAR ALVARADO REYES <br />ALIAS: <br />SEX: MALE SOCIAL SECURITY HUMBER: 505 -41 -197.9 ARMED FORCES: NO <br />DATE OF DEATH: 01/02/2017 DATE OF BIRTH: 07/10/1961 AGE: - 55 YEARS <br />PLACE OF DEATH INFORMATION: <br />TYPE: INTERSTATE ROADWAY <br />FACILITY NAME OR ADDRESS: INTERSTATE 29 MILE MARKER 129 BROOKINGS BROOKINGS SOUTH DAKOTA <br />DISPOSITION INFORMATION: <br />METHOD: REMOVAL FROM STATE <br />CEMETERY: GRAND ISLAND CITY CEMETERY <br />LOCATION: GRAND ISLAND NEBRASKA <br />CREMATORY: <br />LOCATION: <br />DEMOGRAPHIC INFORMATION: <br />RESIDENCE: 2536 WEST 4TH STREET GRAND ISLAND. HALL NEBRASKA 68803 <br />PLACE OF BIRTH: HONDURAS MARITAL STATUS: MARRIED <br />SURVIVING SPOUSE'S NAME, IF WIFE MAIDEN NAME: ADELINA MILLA DE ALVARADO. <br />FATHER'S NAME: JOSE MARIA ALVARADO <br />MOTHER'S NAME PRIOR TO FIRST MARRIAGE: MARIA ANGEL REYES <br />INFORMANT INFORMATION: <br />INFORMANT'S NAME: ADELINA MILLA DE ALVARADO RELATIONSHIP: SPOUSE <br />MAILING ADDRESS: 2536 WEST 4TH STREET GRAND ISLAND, NEBRASKA 68803 <br />FUNS L HO - • DES FUNERAL HOME PO BOX 424 BROOKINGS SOUTH DAKOTA 57006 <br />PART II: CERVICAL SPINE FRACTURE <br />CERTIFIER: HIEB RICHARD S <br />CERTIFIER'S ADDRESS: 400 22ND AVE BROOKINGS SOUTH DAKOTA 57006 <br />MARIAN R POKORNY, STATE REGISTRAR <br />DATE ISSUED:, JANUARY 09, 2017 <br />UNERAL SERVICE L CENSEE: POLLY NICHOLAS R LICENSE NO 1564 <br />CAUSE OF DEATH PART I: MEDICAL CERTIFICATE <br />ASPHYXIA INTERVAL: <br />UPPER AIRWAY MECHANICAL OBSTRUCTION MIUDES <br />DRIVER OF PICKUP IN ROLLOVER IMMEDIATE <br />IMMEDIATE <br />CORONER CONTACTED: YES AUTOPSY PERFORMED: NO AUTOPSY AVAILABLE: <br />ACTUAL OR PRESUMED TIME OF DEATH: 2056 _. <br />INJURY INFORMATION: <br />MANNER OF DEATH: ACCIDENT <br />DATE OF INJURY: 01702/2017 TIME OF INJURY: 20.:56 <br />INJURY AT WORK: NO TYPE OF WORK: <br />PLACE OF INJURY: STREET AND HIGHWAY <br />LOCATION OF INJURY: INTERSTATE 29, MILE. 129 BROOKINGS BROOKINGS SOUTH DAKOTA 57006 <br />HOW THE INJURY OCCURRED: ROLLED TRUCK AND LANDED ON HEAD WITH NECK FORCEBLY FLEXED <br />AGAINST ROOF <br />This is a true certification of the official Vital Record filed in the Department of Health as provided in Chapter <br />34 -25 of the SOUTH DAKOTA CODIFIED LAWS, <br />ISSUED BY BROOKINGS <br />, COUNTY REGISTER OF DEEDS <br />ANY ALTERATION ERASURE OR DUPLICATION VOIDS THIS CERTIFICATE <br />LIDVALIDVAL,DVALIDV <br />'OVALIDVALIDVA..I n'e, <br />VALIDVA,.!DVAL <br />VALID <br />6 <br />