| City | Hermoupolis |
|---|---|
| Year | 1876 |
| Fullname of Deceased | Βουρλάκος Θεόδωρος |
| Father's Name of Deceased | Αναστάσιος |
| Mother's Name of Deceased | Μαριέτα Ρούσσου |
| Age of Deceased | 02 |
| Disease | Γαστροεντερίτις |
| Date of death | 1876 06 11 4μμ |
| Date Registered | 1876 06 12 |
| Origin of Deceased | Ερμ |
| Occupation of Deceased | (not set) |
| Marital Status of Deceased | Βρ.* |
| Record Number | 306 |
| Comments | Μάρτυρες |
| Fullname Registrar | Βουρλάκος Αναστάσιος Μιχ. |
|---|---|
| Age Registrar | 35 |
| Country Registrar | Βάτικα |
| Occupation Registrar | Αλιεύς |
| Relation | Πατήρ |