Province of Manitoba DETAILED DEATH INFORMATION |
---|
REGISTRATION NUMBER: 1899-001688 |
DECEASED DETAILS |
Last Name: YERXA |
Given Names: BERNICE AILEEN |
Sex: FEMALE |
Date of Death: 21/07/1899 |
Time of Death: |
PLACE OF DEATH DETAILS |
Name of Hospital: |
Place of Death: BRANDON |
USUAL RESIDENCE |
Address: |
City, Town, Village, Rural: |
Province: |
Country: |
MARITAL DETAILS |
Marital Status: |
Surname of Husband or Maiden Name of Wife: |
First Names of Spouse: |
OTHER DETAILS |
Occup./Task: |
BIRTH DETAILS |
Date of Birth: |
Age At Death: 3 Units of age: MONTHS |
Place of Birth: |
Province: |
Country: |
PARENT'S DETAILS |
Father's Last Name: |
Father's Given Names: |
Father's Place of Birth: |
Mother's Maiden Last Name: |
Mother's Given Names: |
Mother's Place of Birth: |
INFORMANT'S PARTICULARS |
Relationship to Deceased: |
Address: |
DISPOSITION DETAILS |
Disp. Type: |
Burial/Disp. Date: |
Place: |
Address: |
BURIAL PERMIT DETAILS |
Issued By: |
Address: |
FUNERAL DIRECTOR DETAILS |
Name: |
Address: |
Date of Registration: |