| Consecutive Number | 120 |
|---|---|
| Day of Death | 28 |
| Month of Death | 11 |
| Year of Death | 1919 |
| Place of Death | Infirmary |
| Surname | Rasburn |
| Forename | Sidney |
| Address | 55 Scholes Lane |
| Township | Upholland |
| Age | 18 |
| Occupation or place of work | Coal cutter |
| Name of Official | |
| Cause of Death | Fall of roof in mine |
| Verdict of Case | Accidental |