| Consecutive Number | 111 | 
|---|---|
| Day of Death | 15 | 
| Month of Death | 11 | 
| Year of Death | 1919 | 
| Place of Death | 18 Wallace Lane | 
| Surname | Calland | 
| Forename | Grace | 
| Address | 19 Wallace Lane | 
| Township | |
| Age | |
| Occupation or place of work | Infant of 10 months | 
| Name of Official | Nil | 
| Cause of Death | Natural causes | 
| Verdict of Case | Natural causes |