No. | Name and Surname. Rank or Profession and whether Single, Married, or Widowed | When and Where Died. | Sex. | Age. | Name, Surname and Rank or Profession of Father. Name and Maiden Surname of Mother. | Cause of Death, Duration of Disease, and Medical Attendant by whom certified. | Signature and Qualification of Informant and residence. | When and where Registered and Signature of Registrar. |
57 | Jane Crichton | 1897 April 24, 4.30am | F | 18 | John Crichton Packing box maker | anemia, 5 months. acute nephritis, 2 months | John Crichton, Father | 24 Apr 1897 |