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. |
43 | Record: "Agnes Brown" | 1864 February 26, 8am | F | 60 | Record: "Walter Miller" weaver (Deceased) | asthmatic bronchitis (11 months) | Record: "George Miller", Brother | 26 Feb 1864 |
| Widow of Record: "John Brown", master baker | 56 Causeyside Street, Paisley | | | Record: "Janet Miller" (Deceased), MS Miller | | 18 Gauze Street, paisley (not present) | |