
| Ontario Vital Statistics Death Registration Form | ||
| 1907-1909 | ||
| No. | No. | |
| Microfilm # | ||
| Registration # | ||
| County | ||
| Division | ||
| Name of Deceased | ||
| Sex | ||
| Date of Death | ||
| Age | ||
| Residence, Street No. or Concession and Lot | ||
| Occupation | ||
| Single or Married | ||
| If Single give name of Father | ||
| If Married, give name of Husband | ||
| Where Born | ||
| Cause of Death | ||
| Length of Illness | ||
| Name of Physician in Attendance | ||
| Religious Denomination | ||
| Name of Person making Return | ||
| Date of Registration | ||
| Remarks | ||
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