Information on this page may
not be used for personal or financial gain.
It is to be used for research only. Thank you.
Please understand that some of the handwriting was faded, incomplete, and poorly written,
therefore, some errors in transcribing may have occurred.
Register of Death Information
(1) Full Name of Deceased (2) Date of Death (3) Place of Birth of
Deceased (4) Sex & Color (5) Occupation
(6) Age, Years, Months,
Days (7) Status, Married, Single, Widowed (8) Full Name of Father of
Deceased
(9) Place of Birth of Father of Deceased (10) Full Name of
Mother of Deceased
(11) Place of Birth of Mother of Deceased (12) Place of
Death of Deceased (13) Chief Principal Disease Causing Death (14)
Contributory Disease Causing Death
(15) Did Deceased Undergo A Surgical
Operation, And If So, When And Of What Nature (16) Place of Interment of
Deceased (17) Informant, Doctor, Midwife, or Head of Family
(18) No. of Certificate (19) Remarks