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U.S. Department of State <br />REPORT OF DEATH OF A U.S. CITIZEN OR U.S. NON -CITIZEN NATIONAL ABROAD <br />202402081 <br />Name in full Ngoc Kim Thi PHAM <br />U.S. Consulate General Ho Chi Minh, Vietnam 03-18-2024 <br />Post Date of Issue (mm-dd-yyyy) <br />SSA No. 505-31-6076 <br />Date (mm-dd-yyyy) and Place of Birth 06-26-1946 Vietnam <br />Age 77 <br />Evidence of U.S. Citizenship Regular Passport #647529707 Issued on May 15, 2019 <br />Address in U.S.A. 508 W 15th St Grand Island, Nebraska 68801 United States of America <br />Permanent or Temporary Address Abroad No.9 Du Dinh 6 St, Dong Thanh 2 Group, My Phuoc Ward Long Xuyen City, An Giang Provine, Vietnam <br />Date of death Jan 31 5 00 2024 <br />Month Day Hour Minute Year <br />Place of death No.9 Du Dinh 6 St, Dong Thanh 2 Group, My Phuoc Ward, Long Xuyen City, An Giang Province Vietnam <br />Number and street, or Hospital/ hotel <br />City Country <br />Cause of death Illness according to Death Notice No. 03, Book No. 01/2024/TLKT, <br />Including authority for statement - if physician, include full name and official title, if any <br />issued on Feb 21, 2024 by the People's Committee of My Phuoc Ward, Long Xuyen City, An Giang Province <br />Disposition of the remains Buried <br />Local law governing disinterment of remains provides that Not applicable <br />Disposition of the effects In care of Bay Nguyen, widower <br />Person or official responsible for custody of effects and accounting therefore Not applicable <br />Traveling/residing abroad with relatives or friends as follows: <br />NAME ADDRESS <br />Trang Nguyen 09 Du Dinh 6 Street Dong Thinh 2, Long Xuyen City, An Giang Province, Vietnam <br />Informed by telegram or telephone <br />NAME ADDRESS <br />Copy of this report sent to: <br />NAME <br />Quang Duy Nguyen, son <br />Bay Nguyen, spouse <br />ADDRESS <br />2601 Putty Hill Ave, Parkville MD 21234, USA <br />508W 15th Street Grand Island, NE 68801, USA <br />Notification or copy sent to Federal Agencies: <br />SSA x VA <br />DATE (mm-dd yyyy) <br />NOTIFIED <br />DATE (mm-ddyyyy) <br />SENT <br />3/18/2024 <br />3/18/2024 <br />OPM Other <br />State Agency <br />The original copy of this document and information concerning the effects are being placed in the permanent files of the U.S. <br />Department of: State, passport Vital Records Section, 132 Mercure Cir., Box .,,, Sterling, .,. 20166-1213. <br />Remark;r !r, <br />U.S,t, tss, agt n$tmberw6475`29707 was cancelled and returned to the family. Extract of Vietnamese Death Certificate <br />NglOr1/TL ; lgsuedon gebhOry71, 2024 by People's Committee of Long Xuyen City, An Giang Province, Vietnam. <br />ti <br />DS -2060 <br />02-2018 <br />(Formerly OF -180) <br />VICTORIA ORERO <br />Vice Consul <br />U.S. Consulate General <br />Chi Minh City* Vietn- <br />(Co <br />erse if necessary.) <br />Sig : ture on all copies <br />Consul of the United States of America <br />For Additional Certified Copies, see http://travel.state.gov/content/passport/faq/faq_5057.html <br />0 <br />1 <br />O <br />tZOZ-I£-I0 <br />