| City | Hermoupolis |
|---|---|
| Year | 1876 |
| Fullname of Deceased | Σαμονά Σουσάνα |
| Father's Name of Deceased | Θεόδωρος |
| Mother's Name of Deceased | Καλλιόπη Μπολάκη |
| Age of Deceased | 15 |
| Disease | Χρόν. νόσος |
| Date of death | 1876 05 12 3μμ |
| Date Registered | 1876 05 13 |
| Origin of Deceased | Ερμ |
| Occupation of Deceased | (not set) |
| Marital Status of Deceased | Αγαμος [Θ] |
| Record Number | 245 |
| Comments | Μάρτυς |
| Fullname Registrar | Μπολάκης Μιχαήλ |
|---|---|
| Age Registrar | 45 |
| Country Registrar | Ερμ |
| Occupation Registrar | Οινοπώλης |
| Relation | Συγγενής |