| Consecutive Number | 40 |
|---|---|
| Day of Death | 21 |
| Month of Death | 03 |
| Year of Death | 1917 |
| Place of Death | Infirmary |
| Surname | Hill |
| Forename | John |
| Address | 105 Great George Street |
| Township | Wigan |
| Age | 15 |
| Occupation or place of work | Pony rider |
| Name of Official | Dr Drake |
| Cause of Death | Fractured skull |
| Verdict of Case | Accidental Death |