Churgflhhlfiecord of Deaths 
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
     No. ; Date of Burial g Name of Deceased ' Residence Cause of Death ‘ Date of Death; 
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
       
     
    
   
   
    
     Clergyman’s 
     
     Signature 
     
    
   
   
    
         
     
         
     
    
   
   
    
          
     
    
   
   
    
       
     
    
   
   
    
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