No | When and where died | Name and surname | Sex | Age | Occupation | Cause of death | Signature, description and residence of informant | When registered | Signature of Registrar |
113 | Ninth June 1909 Southwark Infirmary |
Robert Fiveash | Male | 81 years |
General Laborer
15 Cancel Street |
Emphysema Ch. Bronchitis Heart Failure Certified M. M. Adams L.R.C.P. |
E. Gallini Niece 15 Cancel Street, Walworth |
Tenth June 1909 | W. L. Churchill Registrar |