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Transcript of GRO Death Certificate

REGISTRATION DISTRICT  Camberwell
1869  DEATH in the Sub-district of  Dulwich  in the  County of Surrey

No. 1
When and
where died		 2
Name and surname		 3
Sex		 4
Age		 5
Occupation		 6
Cause of death		 7
Signature, description and
residence of informant		 8
When
registered		 9
Signature of
registrar
288 Twenty
first
July 1869
No. 15
Dulwich
College		 Jane
Witt		 Female 77
years		 Widow of
Charles
Witt &
Pensioner of
Dulwich
College		 Disease of semi
lunar valves
of heart known
about 2 years
Syncope a
few hours
Certified		 X The mark of
Emma Squires
Present at the Death
Dulwich		 Twenty
first
July
1869		 Charles
_____ [?]
Registrar

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