Professional Documents
Culture Documents
27899
3.
Steyn
Full first names Jacobus Edward (or Eduard)
Occupation Farmer
4.
Ordinary place(s) of residence during the 12 months prior to death and the Province(s)
5.
Date of birth/Age 64
1.
2.
Surname of deceased
9a.
9b.
10.
7.
11.
Married
If married, place where married Lindley
12.
13.
14.
6.
8.
(a)
Father
(b)
H.J. Steyn
16.
17.
*Capacity
18.
(a)
(b)
If the answer to the previous question is no, did the signatory identify the deceased after his/her death?
Surviving Spouse
2nd
Yes
N/A
State whether signatory is surviving spouse, nearest blood relative or connection residing in the district in which death has taken place; or is caused by such spouse, blood relative or connection to give
this notice; or is required by the Master to submit this death notice.
If the answer to both questions is no, a death certificate or a certified copy must be submitted herewith.
THIS INFORMATION IS COPIED FROM THE ORIGINAL DOCUMENT AND THIS OFFICE ACCEPTS NO RESPONSIBILITY FOR ANY ERRORS OR
MISINTERPRETATIONS THAT MAY BE RECORDED ON THIS FORM