Registration of Deaths

Volume __________ Page __________ Date recorded __________________

Location --

1.Full name of Deceased ---

2. Age ---

3.Place of Death ---

4.Residence of Deceased ---

5. Marital Status --

6. Name of Spouse --

7. Name of Father of Dec. --

8.Name of Mother of Dec.--

9.Occupation -

10. Place of Birth -

11. Date of Birth -

12. Date of Death -

13. Cause of Death -

14 Place of Burial -

15. Informant & Address -

16. Date of Certificate -

17. Date of Registration -

18. Comments -

-

-

=======================================================================================