Ada Helen DALEY, 20 October 1866

Attached To

Death Certificate



SCHEDULE B. 1866. DEATHS in the District of Blackwood in the Colony of Victoria. Registered by David Grieve Stobie, Deputy Registrar.

No.: 263
When and where Died: Twentieth October 1866, Golden Point, Blackwood
Name and Surname: Ada Helen
Rank or Profession: (Blank)
Sex and Age: Female 3 years
Cause of Death: Diptheria
Duration of last illness: One week
Medical attendant by whom certified: ?? Medical Attendant
When he last saw deceased: (Blank)
Name and Surname of Father: Thomas Daley
Rank or Profession: Storekeeper, Blackwood
Name and Surname of Mother: Ellen Murphy
Registration Number: 9805
Signature, Description and Residence of Informant: T. Daley, Father, Golden Point, Blackwood
Signature of Deputy Registrar: David Grieve Stobie
Date and Where Registered: 20th October 1866, Blackwood
When and Where Buried: 21 October 1866, Blackwood Cemetery
Undertaker by whom certified: (Illegible)
Name and Religion of Minister: William ????
Name of Witnesses of Burial: (Blank)
Where Born: Blackwood
How long in the Australian Colonies: (Blank)
Where Married: (Blank)
At What Age: (Blank)
To Whom: (Blank)
Issue in Order of Birth: (Blank)
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