OntarioGenWeb
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Ontario Vital Statistics Death Registration Form
1869-1895
   
  General No. General No.
Microfilm #    
Registration #    
County    
Division    
Name and Surname of Deceased    
When Died    
Sex - Male or Female    
Age    
Rank or Profession    
Where Born    
Certified Cause of Death, and duration of illness    
Name of Physician, if any    
Signature, description and residence of informant    
When Registered    
Religious Denomination of Deceased    
Signature of Registrar    
Remarks    
   
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