|
Registration district
Sub-district |
Hatfield
Hatfield |
Administrative
area
County of Hertfordshire |
|
|
1. Date and
place of death |
|
|
Thirtieth
July 2004
Queen Elizabeth II Hospital, Welwyn Garden City |
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|
|
|
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4. |
Maiden surname
of woman who
has married |
--------- |
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|
5. Date and
place of birth |
|
|
|
25th May 1920 |
Bishop's Stortford, Hertfordshire |
|
|
6. Occupation
and usual address |
|
|
Storeman
(retired)
14 Calton Court, Sele Farm, Hertford, Hertfordshire
|
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7. (a) Name and surname of
informant |
|
Andrea Elizabeth HUMPHREY
|
|
|
(b) Qualification |
|
Niece
Present at the death |
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|
(c) Usual
address |
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|
[ADDRESS IS STILL CURRENT, AND HAS BEEN OMITTED] |
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|
8. Cause of
death |
|
1(a)
(b)
II.
|
Pneumonia
Parkinson's Disease
(R) Hemiarthroplasty (3/7/04)
Revision Hemiarthroplasty (22/7/04); Manipulation ↓G.A. (25/7)
|
|
Certified by T. Thirupathi Rajan MB
|
|
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9. I certify
that the particulars given by me are true to the best of my knowledge and belief |
|
|
Andrea Humphrey
|
Signature
of informant |
|