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DATE OF DEATH day month year 8. RESIDENCE House No* Street Barangay 1 Single Unknown 2 Married b. UNDER 1 YEAR Months Days c* UNDER 1 DAY Hrs/Min/Sec Province TO BE FILLED UP AT THE REGISTRAR 7. CITIZENSHIP 9. CIVIL STATUS FOR OCRG USE ONLY Population Reference No* 10. OCCUPATION 3 Widowed 5 4 Others MEDICAL CERTIFICATE For Ages 0 to 7 days accomplish items 11-17 at the back 17. CAUSES OF DEATH Interval Between Onset and Death I. Immediate cause a* Antecedent cause b. Underlying cause c* II. Ot ...

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