| Deceased | |
| 1. Christian Names and Surname | Francis Frank Bracher |
| 2. Name of Parent or Guardian (if deceased was under the age of ten) | Female |
| 3. Sex | Male |
| 4. Age | 57 Years |
| 5. Race | European |
| 6. Birthplace | England |
| 7. Whether Single, Married, Divorced, Widower or Widow | Married |
| 8. Occupation | Wine & Spirit Merchant |
| 9 Pensioner or Dependent of Pensioner | |
| 10. Date of Death | |
| 11. Place of Death | 110 Henry Street Bloemfontein |
| 12. Usual Place of Residence | 110 Henry Street Bloemfontein |
| 13. Intended Place of Burial | Bloemfontein Cemetery |
| 14. Causes of Death | Carcinoma of Larynx followed by Heart failure |
| 15. Duration of Disease or Last Illness | Approximately two and a half years |
| 16. Name of Medical Practitioner | Dr Otto F.A. Krause Jr |
| Informant | |
| 17. Original Signature | C.L Clark |
| 18. Qualification | Cauting? Burial |
| 19. Residence | 124 Lastion? St Bloemfontein |
Source: FamilySearch - South Africa, Orange Free State, Civil Death Registration, 1902-1954