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Name |
Addalaid Newville |
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Book & Page No. |
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Registration No. |
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Place of Death |
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Residence |
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Date of Birth |
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Age |
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Gender/Color |
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Marital Status |
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Widow |
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Place of Birth |
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Father |
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Father’s Place of Birth |
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Mother |
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Mother’s Place of Birth |
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Occupation |
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Informant |
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Informant’s Address |
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Date of Death |
April 21, 1956 |
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Cause of Death |
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Attending Physician |
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When Signed |
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Place of Burial |
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Date of Burial |
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Funeral Director |
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Date of Return |
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Local Registrar |
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District |
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Explanation of Cause of Death |
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