| No. | 1132 | |
| DESCRIPTION OF DECEASED. | When and where died. | 1903 3 December Costler[sic] Home Epsom |
| Name and Surname. | Michael Foster | |
| Rank, Profession, or Occupation. | Pensioner | |
| Sex and Age. | M 74 Years | |
| CAUSE OF DEATH. | Cause of Death. | Senile decay |
| Duration of last Illness. | ||
| Medical Attendant by whom certified. | Dr King | |
| When he last saw deceased. | 1 December 1903 | |
| PARENTS. | Name and Surname of Father. | |
| Name and, if known, Maiden Surname of Mother. | ||
| Rank or Profession of Father. | ||
| IF BURIAL REGISTERED. | When and where buried. | 5 December 1903 Waikumete |
| Name and Religion of Minister, or Name of Witness of Burial. | Rev G.C Budd Anglican | |
| WHERE BORN | Where born. | |
| How long in New Zealand. | ||
| IF DECEASED WAS MARRIED. | Were married. | |
| At what Age married. | ||
| To whom married. | ||
| If Issue living, state Number, Age, and Sex. | ||
| INFORMANT. | Signature of the Informant. | A.E.S Rynner |
| His or her Description. | Manager | |
| Residence. | Costley Home Epsom | |
| If entry a correction of a former entry, Signature of Witnesses attesting the same. | ||
| REGISTRAR. | Signature of the Registrar. | E. H. Lyons Resr |
| Date of Registration. | 8 December 1903 | |
Source: Certificate