England, death certificate (certified copy) for Samuel Brookes, died 16 November 1908; registered 16 November 1908. West Bromwich district, West Bromwich South West Sub-district, County of West Bromwich; General Register Office, Southport.

Text from source:

CERTIFIED COPY OF AN ENTRY OF DEATH GIVEN AT THE GENERAL REGISTER OFFICE
Registration district West Bromwich
1908 Death in the sub-district of West Bromwich South West in the County of West Bromwich
No. When and where died Name and Surname Sex Age Occupation Cause of death Signature, description and residence of informant When registered Signature of registrar
247 16 Nov 1908 9 Victoria Street U.D. Samuel Brookes Male 70 Engine fitter Cerebral Haemorrhage Certified J. Sansom MRCS Elizabeth Brookes Daughter Present at the death 9 Victoria Street West Bromwich 16 Nov 1908