Queensland Death Certificate
DEATH in the District of Toowoomba
1957 Registered by J. F. Donovan, District Registrar
1957 Registered by J. F. Donovan, District Registrar
in the State of Queensland
Number
1957/5537 25144
DECEASED
Name and surname
Occupation
Sex and Age
Date of Death
Place of Death
Where born and, if not born in Australia,
period of residence in Australia
Name and surname
Occupation
Sex and Age
Date of Death
Place of Death
Where born and, if not born in Australia,
period of residence in Australia
PARENTS
Name and surname of father
Occupation
Name and maiden surname of mother
Name and surname of father
Occupation
Name and maiden surname of mother
MARRIAGE(S)
Where, at what age
and to whom deceased was married
Where, at what age
and to whom deceased was married
CHILDREN
Names and ages
Deceased number and sex
Names and ages
Deceased number and sex
MEDICAL
Cause of death
Duration of last illness
Medical attendant by whom certified
When he/she last saw deceased
Cause of death
Duration of last illness
Medical attendant by whom certified
When he/she last saw deceased
1(a) Cerebral Haemorrhage (b) Hypertension
----
R. GREEN
4 October 1957
BURIAL or CREMATION Registered
When and where buried or cremated
By whom certified
Name and religion of minister, and/or
names of two witnesses of burial or cremation
When and where buried or cremated
By whom certified
Name and religion of minister, and/or
names of two witnesses of burial or cremation
6 October 1957, Jandowae Cemetery
W. E. RAYNER
Ken J. GARDNER, Presbyterian
F. G. PLATZKE, L. DONALD
INFORMANT
Name, description or relationship,
and residence
Name, description or relationship,
and residence
Certified in writing by
E. S. COX, Secretary Manager, General Hospital,
Toowoomba, N. J. McNAMARA, Nephew, Strathgyle, Bell
E. S. COX, Secretary Manager, General Hospital,
Toowoomba, N. J. McNAMARA, Nephew, Strathgyle, Bell
REGISTRAR
Name, date and place of registration
Name, date and place of registration
J. F. DONOVAN, 5 October 1957, Toowoomba
NOTES (if any)
