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Name in full Chanh Trung Ngo <br />Date and Place of Birth 31- Dec -1939 Vietnam <br />Evidence of U.S. Citizenship Regular Passport #075383853 Issued On August 12, 1999 <br />Address in U.S.A. 1511 West Fourth, Grand Island, Nebraska, 68801 United States Of America <br />Permanent or Temporary Address Abroad 04 Yet Kieu, My Binh Ward, Long Xuyen City, An Giang Province, Vietnam <br />Date of death <br />Jan 22 14 2009 <br />(Month) (Day) (Hour) <br />Place of death 04 Yet Kieu, My Binh Ward, Long Xuyen City, An Giang Province <br />(Number and street) or (Hospital or hotel) (City) <br />Cause of death Old Age According To Death Certificate No. 02, Book 1, Issued On 04 February 2009 <br />(Including authority for statement - if physician, include full name and official title, if any) <br />by the Service Of Justice in An Giang Province, Vietnam <br />Disposition of the remains Prepared/Local <br />Local law governing disinterment of remains provides that Not Applicable <br />Disposition of the effects • _ In care of the family <br />Person or official responsible for custody of effects and accounting therefore <br />Traveling/residing abroad with relatives or friends as follows: <br />NAME ADDRESS <br />Hanh My Trung Ngo 04 Yet Kieu, My Binh Ward, Long Xuyen City, An Giang Province, VTNM <br />The original c< <br />Departmentyt5f <br />Remarks: <br />DS -2060 <br />Formerly OF -180 <br />12 -2003 <br />Informed by telegram or telephone <br />Copy of this report sent to: <br />NAME <br />My Thi Nguyen <br />U.S. Department of State <br />Report of Death of an American Citizen Abroad <br />U.S. Consulate General Ho Chi Minh City, 2/18/2009 <br />NAME ADDRESS DATE NOTIFIED a it 70 <br />0 <br />co <br />ADDRESS <br />1511 West Fourth, Grand Island, NE USA 68801 <br />Notification or copy sent to Federal Agencies: SSA VA CSC Other <br />For Additional Certified Copies, see http: //travel.st ate. gov/ passport/consular_records.html. <br />(Post & date of issue) <br />SSA No. 506 -31 -7265 <br />(Minute) <br />(Country) <br />201803980 <br />Age 69 <br />(Year) <br />Vietnam <br />DATE SENT <br />2/18/2009 <br />(State Agency) <br />thtp doeumentand information concerning the effects are being placed in the permanent files of the <br />as'1Ttagton, D.C. 20520 <br />4 + inue on reverse if necessary.) <br />i .ire on all copies) <br />of the United States of America. <br />co <br />0 <br />n. <br />co <br />