Death of Charlotte Jane Fiveash


REGISTRATION DISTRICT WEST HAM
1911 DEATH in the Sub-district of North Leyton in the County of Essex

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
18 Thorpe Road Walthamstow u.d. of
Robert Fiveash
Engineer 		Chronic Nephritis
Bronchitis
Asthema [sic]
Certified
E.G. Carpenter FRCS
A. Cottle
Niece
18 Thorpe Road Walthamstow
 Fourteenth August 1911 C H Penn Registrar
Please note that this is not an exact transcription of the certificate but a standard layout based on the content.