Date and place of death: Tenth February 1978, 20 Clayton Crescent, Blackpool.
Name and Surname: Edith Annie Paine.
Maiden surname of woman who has married: Hindley.
Date and place of birth: 2nd August 1898, Oldham, Greater Manchester.
Occupation and usual address: Wife of John Edward Paine a Fire Security Officer (retired), 20 Clayton Crescent, Blackpool.
Name and surname of informant: John Paine.
Usual address: 199 Caunce Street, Blackpool.
Cause of Death: 1a. Left Ventricular Failure b. Senility. Certified by P. Jensen, L.M.S.S.A.
I certify that the particulars given by me above are true to the best of my knowledge and belief: J. Paine Signature of informant.
Date of registration: Tenth February 1978.
Signature of registrar: Eva Kay, Registrar.
Certified to be a true copy of an entry in a register in my custody.
Eva Kay Registrar 10 FEB 1978 Date IQ 483709
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