(9 bo socompl apioate using Black Int ‘Manipal Form No, 103) Rapubts f the Phimppines voce amomaaned w asaplsi wg Meck (ied lattes) OFFICE OF THE CIVIL REGISTRAR GENERAL CERTIFICATE OF DEATH rove. aa a aa No. a bet Cityitunicipality a 4, NAME (Fr ‘widdle) ood F ‘SEX WMallFemaie) ~| ADELAIDA BAYLON ENIPTO | Female SDATEOF DEATH bor mancYooy [DATE OFBIRTH (On) Woh) ow) |S. AGE ATTHE TIME OF DEATH riieboion soi bape SO ee OF ADEE sven os — sepsune,s979 [eager re | mY FT nap. yan, roan) 7. CIVIL STATUS. Grgaiaricaidow! | 6: PLAGE OF DEATH (ans of HessiavCinaineitonoe No.3 WiomonAnoDivercad) Cagayan Valley Medical Center, Tuguegarao City, ie Cagayan _ __Married_ E.REUIGIONRELIGIOUS SECT | 9. CITIZENSHIP “770, RESIDENCE (auto Wo, Si Barangay OhyMuncpaty,Provins, Gouri) Roman Catholie | Filipino |___Purok o7 Aggasian, City of Magan, Tsubela FF OCUPATION SE NINEGE FATHER Toa Saas EDEN RAE OF MOTHER ti a None NEMECIO BAYLON. ___wenrra.n.panicanta MEDICAL CERTIFICATE | : or ages 0 to 7 days. accomplish Kems 14-19a at the back) 7b. CAUSES OF DEATH (tthe daceasod is aged 8 days anc over) Interval Between Onset end Death 1 Immediatecause =: 8. Septie Shock Antecedent cause b, Sepele Underlying cause o, Ascending Cholangitis _ | 1. omerstgniioant condions contbuing to deat: _ “8, MATERNAL CONDITION (ifthe deceased is female aged 16-49 yeas od) _oweg@ “a. pregnant y pega ine.lesoman42daysater 4 424aysto1 yearater__o, Noneafthe Foti abou fer —* every deivery =" Sole 7d, DEATHBY EXTERNAL CAUSES 7 ]ab. AUTOPSY a Mamer ef ea tonite, se, Acer apie. 6) | eat t-Pucmet Oonence of EXtemel aut (og hore, aco ket sa.) : Zia ATTENDANT 2 Puble - Ti Wades site carton sy) 1 Prato Heath 9: Hostal 5 tes —' Phyalan Ofer 28 atety 4 None” Spey — ero se seme of 2 22. CERTIFICATION OF DEATH hereby certify that the foregoing an a ‘same canbe ascertai il Gath occurred a7807AM__amipm on the date of death spect rs ‘Name in Print. ‘0. COSIDON, MD_ se eg Medical Officer II peas Tt agers thy, * = - - Daifeptemberos,2002 7 ee a cee aa SIBIPR Burial emtanad a sept 3 2 2, NAME AND ADDRESS OF CEMETERY OR CREMATORY i Nebel "26. CERTIFICATION OF INFORMANT 27. PREPAREDEY hereby certify that al Information supplied are true and eoract tomy own knowledge an bei Sige ee some Name in Print| DELSON UBAR Name in Print| ELSAC. LIBAN, Relationship tothe DodAahorized Representative “The orPosiion _ Administrative Assistant IL ‘Address. City of Hagan, Isabela | cow __ September 09, 2022 Date September 09, 2022 28. RECEIVED BY "| 29, REGISTERED BY THE CIVIL) sinatwe signature ‘Name in Print __ | Name in Print Tear Poston we Te or Peston _ ate sep ae _ 2 10 " s90(0)190 19ate)