Queensland Death Certificate
DEATH in the District of Burnett
1883 Registered by Frederick William Roche, District
Registrar
in the Colony of Queensland
Number
184 531
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
PARENTS
Name and surname of father
Occupation
Name and maiden surname of mother
MARRIAGE(S)
Where, at what age and to whom deceased was married
CHILDREN
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
Debility
Since birth
Dr. William HOWLIN
9 July 1883
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
12 July 1883, Cemetery Dalby
Henry MOHOUPT
-------
John Phillip HELSHAM and Robert BUCHANAN
INFORMANT
Name, description or relationship,
and residence
Certified in writing by
James MacNAMARA, Father,
Condamine Street, Dalby
REGISTRAR
Name, date and place of registration
Frederick William ROCHE, 13 July 1883, Dalby
NOTES (if any)