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 |
109 | Twelfth January 1866 Cropwell Butler |
Thomas Miller | Male | 75 years | Farm Labour |
Asthma Certified |
Thomas Miller Present at Death Cropwell Butler |
Thirteenth January 1866 | J. Marriott Registrar |