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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 WILSON | DATE OF DEATH 1924 |
PLACE OF DEATH (Full address or name of hospital)
Stoke |
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FORENAME(S) William Mann | |
OCCUPATION | DATE OF BIRTH or AGE AT DEATH56 |
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, Stoke on Trent Registration Service, Floor 1 Civic Centre, Glebe Street, Stoke-On-Trent, Staffordshire, ST4 1HH, UK |
I requireNUMBER death certificate(s) |
5 REMITTANCE ENCLOSED (POSTAL APPLICATIONS ONLY) | ||
UK: applications should enclose an SAE. Postal order or cheque made payable to :
Stoke-on-Trent City Council for £ 11.00
Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Stoke-on-Trent City 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. |