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DEATH <br />DATE OF DEATH: 29 / 04 / 2017 HOUR: 08:15 P.M. <br />PLACE OF DEATH: RIO BRAVO 11— 70 COLONIA QUINTA VELARDE GUADALAJARA JALISCO <br />PLACE OF DEATH: HIS HOME DEATH CERTIFICATE N °: <br />170336579 <br />LOCATION: TIZAPAN EL ALTO, JALISCO ORDER N ° : 917 <br />CORPSE DISPOSAL: BURIAL <br />NAME OF CEMETERY OR CREMATORIUM: MUNICIPAL <br />CAUSE(S) OF DEATH: HEPATORENAL SYNDROME, HEPATIC CIRRHOSIS, DIABETES MELLITUS TYPE 2 <br />TYPE OF DEATH: DISEASE <br />NAME OF PHYSICIAN THAT CERTIFIED THE DEATH: JORGE ARTURO CAMACHO ROJO <br />DOMICILE: MIGUEL BLANCO 12 -25 PROFESSIONAL IDENTIFICATION CARD N° : 5212109 <br />INFORMANT <br />NAME OF THE INFORMANT : SALVADOR SOLORZANO TAPIA AGE: 26 <br />NATIONALITY: MEXICAN KINSHIP: NONE <br />DOMICILE: AVENIDA LA PAZ 1736 <br />WITNESSES <br />NAME : EVERARDO HERNANDEZ ALONSO KINSHIP: NONE <br />DOMICILE: HIDALGO 1066 AGE: 38 <br />NATIONALITY: MEXICAN <br />NAME : FERNANDO IBARRA MARRON KINSHIP: NONE <br />DOMICILE: HIDALGO 1066 AGE: 36 <br />NATIONALITY: MEXICAN <br />SEAL OF THE BUREAU <br />THE REGISTRY OF <br />RECORDS AND STATISTICS <br />GOVERNMENT <br />TLAQUEPAQUE <br />BUREAU N° <br />REGISTRY OF VITAL <br />RECORDS AND STATISTICS <br />DEATHS <br />OF <br />VITAL <br />OF <br />1 <br />THIS ACT WAS READ AND THOSE WHO INTERVENED, IN AGREEMENT WITH ITS <br />CONTENT, RATIFY ITAND THOSE WHO ARE LITERATE SIGN IT AND THOSE WHO ARE <br />NOT AFFIX THEIR FINGERPRINT. I CERTIFY <br />SIGNATURES <br />[HANDWRITTEN SIGNATURE] <br />INFORMANT <br />[HANDWRITTEN SIGNATURE] <br />[HANDWRITTEN SIGNATURE] <br />WITNESS 1 <br />WITNESS 2 <br />[HANDWRITTEN SIGNATURE] <br />REGISTRAR OF THE REGISTRY OF VITAL RECORDS AND STATISTICS <br />LIC. JUAN ANTONIO MARES RODRIGUEZ <br />THIS ACT HAS THE FOLLOWING OBSERVATIONS ATTACHED: <br />CERTIFICATE MC 426393 <br />3738215 BUREAU RF201704300980100005009183 <br />11 11 11 1 1 IIIIIIIIIItII 1 FG1FI - 286 <br />N° 3738215 <br />201801090 <br />Linda Grimard Di Venerc <br />PERT 0 VRADUCTOR DE LOS irDiOMAS <br />FRANCES ESPANOL Y V!CEVER5A <br />INGLES FSPANNNOL Y VICE <br />INGLES FP `dC LIS Y VICE'FPSA <br />POLIO 125 <br />Vig©ncia 01 Mayo 2017 30Abnl 201E <br />AUTCRLZADO POR EL CONSEJO DE L <br />JUDICATURA DEL ESTADO DE JALISCt <br />