No.

Surname and Name.

Rank or Profession and Condition

(whether Married, Single, Widower or Widow.

When and Where Died,

with Hour of Death.

Sex.

Age.

Parents' Names,

and

Rank, Profession, or Occupation.

Cause of Death, and how long Disease continued Medical Attendant by whom certified, and when he last saw deceased.

Burial Place.

Undertaker, or other Person by whom certified.

Signature, Qualification, and Residence of Informant, if out of the House in which Death occurred.

When and where Registered and Signature of Registrar.

50

Struthers

Agnes

Widow of a

Water Wheel Attendant

(widow)

1859

July Twenty-ninth

1hr. 30min. A.M.

Wood Street, Catrine

F

69

years

John Murphy

Coal Miner

(Deceased)

Elspeth Murphy

M.S. Wallace

(Deceased)

Frailty - Paralysis

2 months

as certified by

James Ballantine M.D.

who last saw Deceased

29th July 1859

Catrine Churchyard

as Certified by

James McKinna

Undertaker

(signed)

Andrew Struthers

Son

(Present)

1859

July 30th

At Sorn

(Signed)

Thomas McWilliam

Registrar