| Consecutive Number | 30 |
|---|---|
| Day of Death | 19 |
| Month of Death | 4 |
| Year of Death | 1919 |
| Place of Death | Infirmary |
| Surname | Jackson |
| Forename | James |
| Address | 51 Moss Lane |
| Township | Platt Bridge |
| Age | 55 |
| Occupation or place of work | Dataller |
| Name of Official | House surgeon, infirmary |
| Cause of Death | Fall of roof in mine |
| Verdict of Case | Accident |