New Zealand Gazette – 1916 – No. 72

Page 2215

✨ Death Registration Form

Registered at __, in the Island of __, Cook Islands. — Retitaiā ki __ i runga i te enua ko __, Kuki Airani.

Deceased.
Ko tei mate.

Entry Number.
Date of Death.
Te ra i mate ei.
Place of Death.
Te ngai i mate ei.
Name.
Tona Ingoa.
Residence.
Tona ngai i noo ei.
Sex.
Tane me e Vaine.
Age (if known).
Te mataiti (me kua kitea).
Name of Husband or Wife (if any).
Te Ingoa a te Tane me ko te Vaine (me kua akai-poipo).
Number and Sex of Children (if any) living.
Te rai a to raua anau, ka akakite me e Tane me e Vaine, ko tei ora mai oki.
Causes of Death.
Te tumu i mate ei.
Duration of Last Illness.
Te roa o te tuatau i te makianga openga.
Name of Medical Practitioner giving Certificate (if any).
Te Ingoa a te Taunga-Taote tei rapakau iaia e tei tata i te pepa no te matenga.
Date when Medical Practitioner last saw Deceased.
Te ra openga i tae atura te Taunga-Taote i te akara i tei mate.

Parents of Deceased.
Nga metua anau o tei mate.

| Father.
Metua Tane. | Mother.
Metua Vaine. |
| --- | --- |
| Name.
Te Ingoa. | |
| Residence.
Te ngai e noo ei. | |
| Description.
Te Tu. | |
| Name.
Te Ingoa. | |
| Residence.
Te ngai e noo ei. | |
| Description.
Te Tu. | |

Informant.
Ko tei apai mai te tuatua akakite.

| Signature.
Tataanga te Ingoa. | |
| --- | --- |
| Residence and Occupation.
Te ngai e noo ei e tana angaanga. | |
| Degree of Relationship (if any) to Deceased.
Eaa te Piritanga ki tei mate, me e Pirianga. | |

Registrar.
Retita.

| Date of Registration.
Te ra i Retitaiā te mate. | |
| --- | --- |
| Signature of Registrar.
Te Ingoa o te Retita. | |

State whether a Native of full blood, or a quarter, half, or three-quarter caste, as the case may be.
E akakite mai me e Maori tikai, me e kuata-papaa, me e aya-papaa, me e toru-kuata-papaa, me eaa.

THE NEW ZEALAND GAZETTE.

JUNE 29.] 2175

VUW Te Waharoa — NZ Gazette 1916, No 72

NZLII — NZ Gazette 1916, No 72

The General Assembly Library (on the right) was completed in 1899 and survived the 1907 fire. Now the oldest remaining original Parliament building, still used as the Parliamentary Library.

✨ LLM interpretation of page content

🌏 Regulations relating to the Registration of Deaths in the Cook Islands (continued from previous page)

Domain🌏 External Affairs & Territories
Dated19 June 1916
KeywordsCook Islands, Deaths, Registration, Regulations, Form

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