| City | Hermoupolis |
|---|---|
| Year | 1878 |
| Fullname of Deceased | Βουτσά Ειρήνη |
| Father's Name of Deceased | Γεώργιος |
| Mother's Name of Deceased | Σταυρούλα Τζιρώνη |
| Age of Deceased | 02 |
| Disease | Περιπνευμονία |
| Date of death | 1878 01 02 4μμ |
| Date Registered | 1878 01 03 |
| Origin of Deceased | Σύρος |
| Occupation of Deceased | (not set) |
| Marital Status of Deceased | Βρ.* |
| Record Number | 3 |
| Comments | Μάρτυρες |
| Fullname Registrar | Βουτσάς Γεώργιος |
|---|---|
| Age Registrar | 50 |
| Country Registrar | Ερμ |
| Occupation Registrar | Βυρσοδέψης |
| Relation | Πατήρ |