Church Record of Deaths 
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
     No. Date of Bunal Name of Deceased 1 Residence 
     
    
   
   
    
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     3 Cause of Death Date of Death I 
     
    
   
   
    
     “I 
     
    
   
   
    
       
     
    
   
   
    
     M7 Clergyman 3 
     
     Signature 
     
    
   
   
    
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