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Prosecutor's Exhibit
"E"
REMARKS/ANNOTATION
"A CERTIFIED PHOTOCOPY"
(SEPT. 30, 1997)
Republic
of the
Philippines
signed: CORA A. ENARGAN
OFFICE OF THE CITY CIVIL REGISTRAR
GENERAL
Asst. Regitration Officer
CERTIFICATE
OF DEATH(
(File out completely, accurately and legibly. Use ink or typewriter,
Place X before
the appropriate answer in kerns 2, 9, 13, 15, 16, 18, 19, 21, and 23)
Province:
Cebu
Registry No.
City/Municipality
Carcar
97-278
1. NAME
(First)
(Middle)
(Last)
MARIJOY
J.
CHIONG
2.
SEX
3. RELIGION 4.
AGE a. 1 YEAR OR
ABOVE b. UNDER 1
YEAR c. UNDER 1 DAY
___ 1. MALE
Completed years
Months
Days Hrs/Min/Sec
X
2. FEMALE R.
C.
21
Sept. 8, 1997
5. PLACE
OF (Name of
Hospital/Clinic/Institution
City/Municipality
Province
DEATH
House No./Street/Barangay)
SITIO TAN-AWAN, GUADALUPE,
CARCAR
CEBU
6. DATE OF
DEATH
(day)
(month)
(year)
7. CITIZENSHIP
17
JULY
97
Filipino
8.
RESIDENCE (House
No., Street,
Barangay)
(City/Municipality)
(Province)
Villa Leyson Subd., Talamban
Cebu
City
Cebu
9. CIVIL
STATUS
10. OCCUPATION
X 1.
Single ___ 3.
Widowed ___ 5. Unknown
___ 2. Married ___
4.
Others
MEDICAL CERTIFICATE
(For ages 0 to 7 days, accomplish 11-17 at the
back)
17. CAUSES OF
DEATH
Interval
Between Onset and Death
Immediate cause
MEDICO-LEGAL CASE
Antecedent cause
Underlying cause
Other significant condition
contributing to
death
18. DEATH BY NON-NATURAL CAUSES
a. Manner of death
___ 1. Homicide ___ 2.
Suicide ___ 3. Accident ___ 4. Others (Specify)
_____________
b. Place of Occurence (e.g. home, farm, factory,
sea, etc.
___________________________
19.
ATTENDANT
If attended, state duration
___ 1. (Private physician)
________________________________________
___ 2. ((Public Health Officer)
_____________________________________
___ 3. (Hospital Authority)
________________________________________
20. CERTIFICATION OF DEATH
I hereby certify that the foregoing
particulars are correct as near as same can be ascertained and further
certify that I
___ have not attended the deceased
___ have attended the deceased and the death occurred
at _____ am/pm on the date indicated above
Signature
signed:
Name in Print P/SINSP.
NESTOR A. SATOR,
MD
Title or Position MEDICO
LEGAL
OFFICER
Address PNP
Regional Crime Lab.
Off.
Camp Cabahug, Gorordo Ave., Cebu City
Date
July 25, 1997
21. CORPSE
DISPOSAL
22. BURIAL/CREMATION
PERMIT
23. AUTOPSY
___ 1. Burial ___ 3. Others
(Specify)
Number
8434587
___ 1. Yes
___ 2. Cremation
____________
Date issued
7-25-97
___ 2.
No
24. NAME AND ADDRESS OF CEMETERY OR CREMATORY
25. INFORMANT
Signature
signed:
Address Same
as the above
Name in Print
Cheryl S.
Jimenea
Relationship
to deceased Auntie
Date
July 24,
1997
26. PREPARED
BY
27. RECIEVED AT THE OFFISE OF
Signature
signed
Signature
signed
Name in Print
Jonathan D. Obregon
Name in Print CORA A. ENARGAN
Title or Position
CRH - Liason Officer
Title or Position Asst. Registration Officer
Date July 24,
1997
Date July 30,
1997
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