Severin Rakowski DALEY, 25 March 1906

Attached To

Death Certificate

Death-Certificate.jpg

Transcript

THIRD SCHEDULE. DEATHS in the District of Armadale in the State of Victoria. Registered by C. H. C. Bolann.

No.: 2142
When and where Died: 25th March 1906, 12 Avondale Road, City of Prahran, County of Bourke
Name and Surname: Severin Rakowski Daley
Rank or Profession: None
Sex and Age: Male 18 yrs
Cause of Death: 1) Meningitis, 2) Convulsions, Coma
Duration of last illness: 1) 7 Weeks, 2) 1 Day
Medical attendant by whom certified: Dr. C. Trood
When he last saw deceased: 23rd March 1906
Name and Surname of Father: John Henry Daley
Rank or Profession: Genntleman
Name and Surname of Mother: Helene Daley formerly Radowski
Registration Number: 85
Signature, Description and Residence of Informant: Frank Garson, Authorised Agent, 177 High St, Prahran
Signature of Deputy Registrar: C. H. C. Bolann
Date and Where Registered: 28th March 1906, Armadale
When and Where Buried: 27th March 1906, St Kilda Cemetery
Undertaker by whom certified: F Garson (Drayton & Garson)
Name and Religion of Minister: (Illegible)
Name of Witnesses of Burial: (Illegible)
Where Born: Richmond, Victoria
How long in the Australian Colonies: 18 years
Where Married: Single
At What Age: (Blank)
To Whom: (Blank)
Issue in Order of Birth: (Blank)
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