BCT /54107 CERTIFIED COPY OF AN ENTRY Pursuant to the Births and Deaths Registration Act 1953 DEATH [entry Ne. 16 Registration district Camden ‘Administrative area Sabsdistrict | Camden London Borough of Camden ind place of deat pues Ce ne TTS ‘Twenty-second June 2024 ‘National Hospital For Neurology and Neurosurgery, Queen Squere, Camden. 2 Name and sormame Te MA 7 Jean May Marion GO? Female 4. Maiden surname IAA ofwoman whe LANG. Ba) NS thas married Date and place af Biewh Eighth May 1938 | __ Bishopsteighton, Devon 6 Occupation and wsual address Health Visitor (retired) Wile of Leonardo GONELLA, Restaurateur / Musical Instrument Maker (retired) 32 Cotswold Gardens, London, NW2 71a) Name and surname ofinformant (6) Qualification Andrew Peter GONELLA, Step-Son 2 Bramley Close, London, NW7 '% Teeny thatthe partioulars given by me above-are tue othe best of my knowledge and bali AP. Gonella of informant 3 Cause of death 1 (a) Spontaneous Intracranial Haemorrhage Certified by Benjamin Sacks MB 10. Date of registration Th Signature of registrar S14 ‘Twenty-seventh June 2024 } 7 MStaer Deputy Registrar CCertfid tobe ate copy ofan entry in resister in my eustody Per ce “Superintendent Registrar Registrar “iis whichever doe oars CAUTION: THERE ARE OFFENCES RELATING TO PALSIFYING OR ALTERING A CERTIFICATE AND USING ‘OR POSSESSING A FALSE CERTIFICATE, °CROWN COPYRIGHT System No. 527576657 WARNING: A CERTIFICATE IS NOT EVIDENCE OF IDENTITY.