CERTIFIED COPY OF AN ENTRY OF DEATH GIVEN AT THE GENERAL REGISTER OFFICE

Application Number 1095386/6

REGISTRATION DISTRICT Hemel Hempstead

296 DEATH in the sub-district of Hemel Hempstead In the county of Hertford

Columns:- 1 2 3 4 5 6 7 8 9

No When and Name and Surname Sex Age Occupation Cause of death Signature, description When Signature
where he died and residence of registered of registrar
informant

Twentieth of 79 Ia. Cerebral Haemorrhage G S Lewis Twenty B.A Birch

February 2010 Longlands b. Hypertension second
500 Richard Villa Male 62 Hemel 30 Dellcut Road February Registrar
St. Paul's years Hempstead II. Previous episode Hemel Hempstead
Hospital Dec. 2001 2010
Contractor
Hemel Certified by
Hempstead P.B Savege LMSSA

CERTIFIED to be a true copy of an entry in the certified copy of a Register of Deaths in the District above mentioned.

Given at the GENERAL REGISTER OFFICE, under the Seal of the said Office, the 13th day of October 2010

DYC 275196

ASC
CAUTION: THERE ARE OFFENCES RELATING TO FALSIFYING OR ALTERING A CERTIFICATE AND
USING OR POSSESSING A FALSE CERTIFICATE CROWN COPYRIGHT
WARNING: A CERTIFICATE IS NOT EVIDENCE OF IDENTITY.
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