Queensland Death Certificate
DEATH in the District of Blackall
1957 Registered by T. A. Eaton, District Registrar
1957 Registered by T. A. Eaton, District Registrar
in the State of Queensland
Number
1957/002737 000021
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. Chronic pyaemia 2. Senility
1. 3 months
H. W. HARBISON
4 July 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
5 July 1957, Blackall Cemetery
T. M. BOHAN
E. H. FRAHER, Roman Catholic
J. McKEAN, K. L. SMITH
INFORMANT
Name, description or relationship,
and residence
Name, description or relationship,
and residence
Certified in writing by
E. J. ALLAN, Matron, District Hospital
Blackall
E. J. ALLAN, Matron, District Hospital
Blackall
REGISTRAR
Name, date and place of registration
Name, date and place of registration
T. A. EATON, 5 July 1957, Blackall
NOTES (if any)
