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## SECTION XV1. FULL NAME (Last-First-Middle)Florez, Agustina2. LIVING: Yes3. DATE OF DEATH: June 19934. CAUSE OF DEATH: Natural5. STATE OTHER NAMES SHE HAS USEDINDICATE CIRCUMSTANCES including length of time) under which SHE has ever used these names. IF LOCAL CHANGE GIVE PARTICULARS and by what authority; USE EXTRA SPACE PROVIDED ON PAGE 19 OF THIS FORM TO RECORD THIS INFORMATION.6. CURRENT ADDRESS (Give Last Address, if Deceased) (Street, City, State, Country)3. Austin and Lee Str. Sta., Seguin, Texas7. DATE OF BIRTHSeptember 20, 19038. PLACE OF BIRTH (City, State, Country)Mary Ortega, Nuevo Leon, Mexico9. CITIZENSHIP: Mexican13. IF BORN OUTSIDE U.S. DATE OF ENTRY: Unknown11. PLACE OF ENTRY: Unknown12. FORMER CITIZENSHIP(S) (Country/ies): NA15. DATE U.S. CITIZENSHIP ACQUIRED: NA16. WHERE ACQUIRED (City, State, Country): NA16. PRESENT EMPLOYER (Give last employer, if worker is deceased or unemployed): NA17. EMPLOYER'S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED: NA18. DATES OF MILITARY SERVICE (From-To): NA19. BRANCH OF SERVICE: NA20. COUNTRY: NA21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN: NA## SECTION XVI BROTHERS AND SISTERS (Including Half, Step and Adopted Brothers and Sisters)|                                                              |                          || ------------------------------------------------------------ | ------------------------ || 1. FULL NAME (Last-First-Middle)                             | 2. RELATIONSHIP          || Palan, Frances                                               | Sister                   || 4. CURRENT ADDRESS (No., Street, City, Zone, State, Country) | 3. CITIZENSHIP (Country) || 631 S. River St., Seguin, Texas                              | U.S. of America          ||                                                              | 5. AGE                   ||                                                              | 6. LIVING: Yes           || 1. FULL NAME (Last-First-Middle)                             | 2. RELATIONSHIP          || Pentoria, Rachel                                             | Sister                   || 4. CURRENT ADDRESS (No., Street, City, Zone, State, Country) | 3. CITIZENSHIP (Country) || 311 Lambert St., San Antonio, Texas                          | U.S. of America          ||                                                              | 5. AGE: 39               ||                                                              | 6. LIVING: No            || 1. FULL NAME (Last-First-Middle)                             | 2. RELATIONSHIP          || Black, Rebecca Mary                                          | Sister                   || 4. CURRENT ADDRESS (No., Street, City, Zone, State, Country) | 3. CITIZENSHIP (Country) || 501 S. Guadalupe St., San Marcos, Texas                      | U.S. of America          ||                                                              | 5. AGE: 34               ||                                                              | 6. LIVING: Yes           || 1. FULL NAME (Last-First-Middle)                             | 2. RELATIONSHIP          || Flores, Samuel                                               | Brother                  || 4. CURRENT ADDRESS (No., Street, City, Zone, State, Country) | 3. CITIZENSHIP (Country) || Rosemary and Lee St., Seguin, Texas                          | U.S. of America          ||                                                              | 5. AGE: 42               ||                                                              | 6. LIVING: Yes           || 1. FULL NAME (Last-First-Middle)                             | 2. RELATIONSHIP          || Flores, Joe                                                  | Brother                  || 4. CURRENT ADDRESS (No., Street, City, Zone, State, Country) | 3. CITIZENSHIP (Country) ||                                                              | U.S. of America          ||                                                              | 5. AGE: 33               ||                                                              | 6. LIVING: Yes           || 1. FULL NAME (Last-First-Middle)                             | 2. RELATIONSHIP          || Flores, Juan                                                 | Brother                  || 4. CURRENT ADDRESS (No., Street, City, Zone, State, Country) | 3. CITIZENSHIP (Country) ||                                                              | U.S. of America          ||                                                              | 5. AGE: 31               ||                                                              | 6. LIVING: Yes           |