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| Year | 1971 |
| When and Where | Seventeenth November 1971 General Hospital Hereford |
| Cause | (This information has not been transcribed) |
| Age | Date and Place of Birth: 8 March 1904 Leominster |
| Occupation | Railway Stationmaster (Retired), Station House, Pontrilas, Hereford |
| Informant | Williams Richard Rollings, Qualification: Causing the body to be buried |
| Registration District | Hereford |
| Sub-District & City / County | Hereford, County of Hereford |
| Source / Reference | Death Certificate |