HB 9750 Cl

CERTIFIED COPY of an ENTRY OF DEATH D. Cert,

S.R.
Pursuant to the Births an Deaths Registration Act 1953

Registration District ¥ho<we*u>tSGi

1837 Death in the Sub-District of $a&Mfa?d (n the tiwnty of cA(idd£t6Uc
Columns:— \ i 3 4 s 6 7 8 9
When and Signature, description, and When Signature of
No. Name and surname Sex Age Occupation Cause of death
where died residence of informant registred registrar

£726 ITcv&mfet o&nd ffbtuj cMak 54 Sci&ntut, 'Xtattattatk V&ttifcate, mewed TZawmfe
17M,W7 ftofatw yeaM ficmi'D.Zbee.'Cownvi, 17M.i&7
fix. dKiddfucjX.
Sic/fad mi* g.Ufa&on,
3(o4pital Vnguett 4e£d
c Registrar.
nwem$ex.~17tt,W7

Certified to be a true copy of an entry in a register in my custody.

Supcriniendcni Registrar.

Da,e.
CALTION . - - • Any person »ho (1) falriAci w\j of the pwticulvrt on (his ariinc»i«, or
(2) utci a filsllled ccrUflcate M true, knowing II (o be ftlfc, is liable lo prosecution.

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