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OPTIONAL FORM 180 (Nov. 12-81) <br />(FORMERLY FS -192) 200412492 <br />DEPT. Of STATE <br />50180 -104 <br />REPORT OF THE DEATH OF AN AMERICAN CITIZEN ABROAD <br />American Consulate, Matamoros, Mexico, June 5, 1996 <br />--------------------------------------------------------------- <br />(Post dt date of issue) <br />SSA No._155 -48 -3489 <br />Name in full____ James Kenneth FREInt <br />Date and Place of Birth_ June _ 14 ,- 1954 , New Jersey_ - <br />Evidence of U.S. Citizenship _U.__S __ Passp9rt__ #G64501.8_, issued July 29,1986 Houstl <br />Address in U.S.A. 2723_ N. _North Road, -- Grand_ I s l and , _ NE 6 8 8 0 3 <br />-------------------------- <br />Permanent or Temporary Address Abroad ----- N / A <br />------------------------------------------ <br />Date of death ------- MaY----- - - - - -- 30------------ 8---------- - - - -00 - - -- 1996 - - -- <br />(Month) (Day) (Hour) ----------"---- - <br />(Minute) (Year► <br />Place of death _ H? ghway_ Victoria -Tula ,_ _ "El Chihue" ,_ Ja�ve , Tamaulipas , _Mexico <br />(Number and street) or (Hospital or hotel) y - - - - - - - (Country) <br />(C1t ) <br />Cause of death_ - Cranial I_ thoracicoabdominal� trauma, according to <br />(lncTudtng aut(arity for statement =if pi�'ysiaan, Include full -name iij W- al tiife: d w )------ <br />Dr. Jose E. Gonzalez, coroner. <br />- ---- -----Leal- - ----- <br />------------ - ------------- <br />--------------------------------------- <br />Disposition of the remains. _ -Sent _ the _ . . <br />- - to- - U. - ---S ---- for ------burial --------------------------- - - - - -- <br />------------------------------------------------------------------------------------- <br />Local law governing disinterment of remains provides that _ _ ­N / A <br />------------------------------------------------------------------------------ <br />Disposition of the effects._ Returned to next -of- kin in Grand Island, NE <br />Person or official responsible for custody of ettects and accounting therefor - _Lori_ Frew, <br />wife. <br />Travefin&rAtftg abroad with relatives or friends as follows: <br />NAME ADDRESS <br />James- -K. --Frew- -- <br />, Jr., -- - <br />son, died in - - same accident. <br />---------------- - - - - -- --------------------------------- <br />Informed byNW3qp= or telephone <br />NAME ADDRESS <br />DATE SENT <br />Ms . Lori Frew 2723-N.--North-Road,-Grand Island -,- -May 3 0-, 1.9.9 6 <br />--------- <br />NE 68803 <br />------------------ - - - - -- <br />Copy of this report sent to: <br />NAME ADDRESS DATE SENT <br />Ms. - Lori _Frew__ -- 2723-N.-North- Road, Grand Island, June-5,--1996 <br />-------------------------------- - - - - -- -------------- <br />NE 68803 <br />----------------------------------- - - - - -- ----------- - - - - -- <br />Notification or copy sent to Federal Agencies: SSA X VA CSC_Other <br />The original copy of this document and information concerning the effects are being (State <br />laced to he <br />permanent files of the Department of State, Washington, D.C. 20520. <br />Remrkrt'_ _3 Passport__#G645018 returned with ersonal_ effects <br />�:. <br />r, - -------------------------------P ---- - - - - -- <br />_ which _were__rejurned__to -the -U. S,_ with_Edward_Whalen;__passport <br />was not ..�`anc81 ed . _ _ _ - _ _ _ (Continue reverse if necessary.) <br />1 <br />%'. (Signatu on all copies) off <br />[sEAts} Vice Cons u the U ' ed States of America. <br />Additiorod oert>4'i �eopies available from The Correspondence Branch, Passp�*$pry, Department of State <br />Washington, D.C. 20624. Each coprW. 1 U V <br />* GPO : 1985 0 - 461 -275 (20028) <br />a <br />e <br />3 <br />g <br />I <br />C4 <br />a <br />(D <br />En <br />P11 <br />(D <br />(D <br />rt <br />m <br />Q, o <br />rn <br />