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2 Please state your relationship to the person
to whom the certificate relates: |
3 DETAILS OF DEATH CERTIFICATE REQUIRED | |
SURNAME OF DECEASED JOHNSON | DATE OF DEATH 1919 |
PLACE OF DEATH (Full address or name of hospital)
St Helens |
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FORENAME(S) Nellie | |
OCCUPATION | DATE OF BIRTH or AGE AT DEATH- |
HOME ADDRESS | If a married woman, please give name and surname of husband |
4 REQUIREMENTS | Send this Application to: |
DEATH CERTIFICATE £11.00 | Superintendent Registrar,St Helens Registration Service, St Helens Town Hall, Victoria Square, St Helens WA10 1HP |
I requireNUMBER death certificate(s) |
5 REMITTANCE ENCLOSED (POSTAL APPLICATIONS ONLY) | ||
UK: applications should enclose an SAE with a Postal Order payable to :
St Helens Council for £ 11.00
Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Postal Order payable to : St Helens Council |
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The Fee for a certificate issued against this form 'as printed' will not be
refunded. You are strongly recommended to add any qualifying information you may have in order to help the registrar issue the correct certificate. |