APPLICATION FOR A DEATH CERTIFICATE PLEASE READ THESE NOTES before completing this form.

Death Certificate Tameside : AUD/33/32

1 TO BE COMPLETED BY THE APPLICANT Name of applicant Mr Mrs Miss/Ms (STATE NAME IN FULL) Full postal address   Post Code: Telephone no: e-mail address:

2 Please state your relationship to the person to whom the certificate relates:

3 DETAILS OF DEATH CERTIFICATE REQUIRED
SURNAME OF DECEASED BARSTOW	DATE OF DEATH 1889
	PLACE OF DEATH (Full address or name of hospital) Audenshaw
FORENAME(S) Sydney
OCCUPATION	DATE OF BIRTH or AGE AT DEATH0
HOME ADDRESS	If a married woman, please give name and surname of husband

4 REQUIREMENTS	Send this Application to:
DEATH CERTIFICATE £11.00	See section 5 below.
I requireNUMBER death certificate(s)

5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)

Tameside no long accept orders via these forms. To place an order please use the online ordering system or contact the Register Office by telephone to make a payment on +44 (0)161 342 5032