| City | Hermoupolis |
|---|---|
| Year | 1877 |
| Fullname of Deceased | Περιφανάκη Σταματούλα |
| Father's Name of Deceased | Μιχαήλ |
| Mother's Name of Deceased | Σταματούλα Σμίρου |
| Age of Deceased | 06 μην |
| Disease | Δράκος |
| Date of death | 1877 12 26 4,, |
| Date Registered | 1877 12 27 |
| Origin of Deceased | Ερμ |
| Occupation of Deceased | (not set) |
| Marital Status of Deceased | Βρ.* |
| Record Number | 722 |
| Comments | Μάρτυς |
| Fullname Registrar | Περιφανάκης Μιχαήλ |
|---|---|
| Age Registrar | 27 |
| Country Registrar | Χίος |
| Occupation Registrar | Οπωροπώλης |
| Relation | Πατήρ |