| City | Hermoupolis |
|---|---|
| Year | 1893 |
| Fullname of Deceased | Φόρτσος Ιωάννης Ξενοφ. |
| Father's Name of Deceased | Ξενοφών |
| Mother's Name of Deceased | Αννίτσα Ιω. Βαλαντάση |
| Age of Deceased | 01 ημ |
| Disease | [Ατέλεια;] |
| Date of death | 1893 08 30 6μμ |
| Date Registered | 1893 08 31 |
| Origin of Deceased | Ερμ* |
| Occupation of Deceased | (not set) |
| Marital Status of Deceased | Βρ.* |
| Record Number | 422 |
| Comments | (not set) |
| Fullname Registrar | Βαλαντάσης Γεώργιος |
|---|---|
| Age Registrar | 47 |
| Country Registrar | Ερμ |
| Occupation Registrar | Καφεπώλης |
| Relation | Θείος |