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[Page 53]
Form No 12.
No. of Certificate 15
DEATHS in the District of Randwick in the State of New South Wales.
Registered by Ernest Henry Strachan District Registrar.
1. No. in Register – 115
2. Description - When and where died – 8th April 1919 No. 4 Aus General Hospital Randwick (late of West Australia
3. Name and surname, rank or profession. – George Underwood Fraser Alley
Soldier & Superintendent of Works (Public Service
4. Sex and age – Male 39 years
5. Cause of death; duration of last illness; medical attendant by whom certified; and when he last saw deceased. – Pneumonic Influenza. Broncho-pneumonia Broncho pneumonia, Cardiac failure – K.M. Garrett, MB Ch. M (registered) 8 April 1919
6. Christian name and surname of father, if known, with rank or profession. – Alfred Underwood Alley. Commercial Traveller
Christian and maiden surname of mother. – Ann Isabella. Fraser.
7. Signature, description, and residence of informant. – C. Collins – Private. No. 4 Aus. General Hospital Randwick.
8. Signature of District Registrar, date, and where registered. – E.H. Strachan 9th April 1919 Randwick
9. If burial registered – When and where buried – 10th April 1919 Presbyterian Cemetery Gore Hill
Undertaker by whom certified – Wood Coffill & Co. Ltd.
10. Name and religion of Minister; names of witnesses of burial – Arthur J. Wade, Presbyterian E Hawkings Thomas Ryan
11. Where born, and how long in the Australasian Colonies or States, indicating which. – Orange. N.S. WALES
12. If deceased was married – Where, and at what age, and to whom. – Port Arthur. Canada about 27 years Emma Caufield No issue
I, Ernest Henry Strachan do hereby certify that the above is a true copy of an entry in a Register of Deaths kept at the District Registrar's Office, at Randwick and extracted this 26 day of May 1919
EM Strachan
District Registrar.
[Official stamp of New South Wales registrar of Births, Deaths and Marriages district of Randwick At Randwick]