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} w., U.S. Department of State 2 0 0 9 0 7 0 2 5 Report of Death of an American Citizen Abroad _ _U.S. Consulate General _Ho_Chi Minh City, 2/18/2009_ _ - - T (Post & date of issue) - - - - T SSA No. 506-31-7265 Name in full Chanh Trun N go Age 69- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Date and Place of Birth 3i-Dec-1939 Vietnam - - ,.~T__------ Evidence of U.S. Citizenship Regular Passport #075383853 Issued On August 12, 1999 - - - - T z Address in U.S.A. . 1511 West Fourth, Grand Island, Nebraska, 68801 - United States Of America CD o Permanent or Temporary Address Abroad 04 Yet Kieu, My Binh Ward, Long Xuyen City, An Giang Province, Vietnam - Date of death _Jan 22 14 _ _ 2009 (Month) (Day) - - T (Hour) - - - - (Minute) - - - (Year) - l Place of death 04 Yet Kieu, My Binh Ward, Long Xuyen City, An GianProvince_ _Vietnam (Number and street) or (Hospital or hotel) (City) - (Country) Cause of death Old Age According To_Death _Certificate No. 02, Book 1, Issued On 04 February 2009 - T - (including authority for statement - if physician, include full name and official title, if any) - J - Eby the Service Of Justice in An Giang Province, Vietnam - - - - - Disposition of the remains _Prepared/Local - 0 1 Local law governing disinterment of remains provides that Not Applicable - - - - - Disposition of the effects _ In care' of the family - - - - - - - - - - - - - - - - - - Person or official responsible for custody of effects and accounting therefore - - ^ - - - - - - - - ~ - Traveling/residing abroad with relatives or friends as follows: NAME ADDRESS - Hanh My Trung Npgo - - - - - 04 Yet Kieu, My Binh Ward, Long Xuyen City, An Giang Province, VTNM - - Informed by telegram or tel'e'phone NAME ADDRESS DATE NOTIFIED ~ X cv - - - - - - - - - - - - - Copy of this report sent to: NAME - - es - ~ur ~ADDRESS - - - 88 - -DATE SENT - - - - My Thi Nguyen- - - - 15 11 -West Fourth, Grand Island, NE USA 68801 2/18/2009 -Notification.or copy sent to Federal Agencies: SSA VA CSC Other _ _ - - (State Agency) - N The original copy.Qf this document and information concerning the effects are being placed in the permanent files of the co DepartrA e'nt o Mahe, WashiF8ton, D,C. 20520 a r CD C) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - t x a on reverse if necessary.) R jSj~$L all copes). Martin Oppus of the United States of America... ,,.Consul. V, DS-2060 For Addiuonal.Certified Copies, see http://travel.state.gov/passporVconsular_records.html, Formerly OF-180 12-2003