Queensland Death Certificate
DEATH in the District of Burnett
1936 Registered by James Herbert Pill, Acting District Registrar
1936 Registered by James Herbert Pill, Acting District Registrar
in the State of Queensland
Number
3790 3814
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
Henry Ernest NICOLL aka Henry Ernest BRAY
Labourer
Male, 66 years 8 months 2 days
17 December 1936
Mundubbera Hospital
Brisbane, Queensland
Life Queensland
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
Living - Henry Reginald 42, Margaret Ellen 37,
Florence Ethel 36, Lorna Beatrice 32
-----
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. Chronic Valvular Heart Disease, 2. Arterio-Sclerosis
3. Heart Failure
1. About 2 years
S. V. O'REGAN
17 December 1936
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
18 December 1936, Gayndah Cemetery
W. R. HARRIS
Thomas H. CHERRY, Methodist
A. G.KIRK, F. IMHOFF
INFORMANT
Name, description or relationship,
and residence
Name, description or relationship,
and residence
Certified in writing by
M. E. HARMAN, Daughter
Wetherton
M. E. HARMAN, Daughter
Wetherton
REGISTRAR
Name, date and place of registration
Name, date and place of registration
J. H. PILL, 21 December 1936 Gayndah
NOTES (if any)
