http://www.geneofun.on.ca/ongenweb
| Ontario Vital Statistics Death Registration Form | ||
| 1910-1912/3 | ||
| Microfilm # | ||
| Registration # | ||
| County | ||
| Division | ||
| Full Name of Deceased | ||
| Sex, and Race | ||
| Date of Death | ||
| Date of Birth | ||
| Age and Place of Birth | ||
| Place of Death | ||
| Occupation | ||
| Single, Widowed or Divorced | ||
| Full Name of Father | ||
| Birthplace of Father | ||
| Maiden Name of Mother | ||
| Birthplace of Mother | ||
| Name of Physician who attended Deceased | ||
| Certified by | ||
| Address | ||
| Date | ||
| Medical Certificate of Death | Medical Certificate of Death | |
| Name | ||
| From | ||
| To | ||
| That I last saw h.... alive on | ||
| That the Death occurred on | ||
| Primary Cause of Death | ||
| Duration | ||
| Immediate Cause of Death | ||
| Duration | ||
| Physician's name | ||
| Address | ||
| Date | ||
| Copyright © Ontario GenWeb | ||