The People’s Committee Commune: Lien Bat District: Ung Hoa Province: Ha Tay SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness ---Model: TP/HT-1999-C.2 No: 01 Book: 01 Dea
Trang 1The People’s Committee
Commune: Lien Bat
District: Ung Hoa
Province: Ha Tay
SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness
-Model: TP/HT-1999-C.2
No: 01 Book: 01
Death Certificate
(Re-registration)
Full name: Bui Dam Quang Sex: Male
Date of birth: May 3rd, 1942
Ethnic group: Kinh Nationality: Vietnamese
Native place (1): Bat Chua – Lien Bat – Ung Hoa – Ha Tay
Residence address/Last temporary address (2): Lien Bat – Ung Hoa – Ha Tay
ID No./ alternative documents (3):
No.:
Issued in………on………
Died at ………on February, 25th, 2001
Place of death: Bat Chua – Lien Bat – Ung Hoa – Ha Tay
Cause of death: Suddenly catching cold
Officer in charge of Birth, Marriage, Death
(Name, position, signature)
Lien Bat, May, 15th, 2006
On Behalf of the People’s Committee
Vice-Chairman
(Signed and sealed)
Notary
NGUYEN THI MINH TAM
Certified as original copy
Date: May 30th, 2006
Number: 382 Book: 05 CN-BS