Ada Helen DALEY, 20 October 1866

Attached To

Death Certificate

Death-Certificate.jpg

Transcript

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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