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 |
119 | Thirteenth August 1911 West Ham Union Infirmary u.d. |
Charlotte Jane Fiveash | Female | 83 years |
Widow
of
Robert Fiveash Engineer 18 Thorpe Road Walthamstow u.d. |
Chronic Nephritis Bronchitis Asthema [sic] Certified E.G. Carpenter FRCS |
A. Cottle Niece 18 Thorpe Road Walthamstow |
Fourteenth August 1911 | C H Penn Registrar |