| Consecutive Number | 114 |
|---|---|
| Day of Death | 20 |
| Month of Death | 11 |
| Year of Death | 1918 |
| Place of Death | Infirmary |
| Surname | Shambley |
| Forename | John |
| Address | 1 Holt Street |
| Township | Higher Ince |
| Age | 68 |
| Occupation or place of work | dataller |
| Name of Official | House surgeon Infirmary |
| Cause of Death | Accidental death - fall of roof |
| Verdict of Case | Accidental |