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Municipal Form No. 103 Revised January 1993 To be accomplished in quadruplicate REMARKS/ANNOTATION Republic of the Philippines OFFICE OF THE CIVIL REGISTAR GENERAL CERTIFICATE OF DEATH Fill out completely accurately and legibly. Use ink or typewriter. Place X before the appropriate answer in items 2 9 13 15 16 18 19 21 and 23. Province Registry No* City/Municipality 1. NAME First Middle Last 4. A 2. SEX 1 MALE RELIGION 5. PLACE OF DEATH G E a* 1 YEAR OR ABOVE Completed 2 Years Name of...