| 1. Christian names and surname | Richard Edward Drury Lown |
| 2. Name of parent or guardian (if deceased was under the age of ten) | |
| 3. Sex | Male |
| 4. Age | 47 years |
| 5. Race | European |
| 6. Birthplace | Namaqualand Cape Province |
| 7. Whether single, married, divorced, widower, or widow | Married |
| 8. Occupation | Ine Owner |
| 9. Pensioner or dependent on pensioner | No. |
| 10. Date of death | Sixth October 1943 |
| 11. Place of death | Florence Nightingale Nursing Home Johannesburg |
| 12. Usual place of residence | 014 Killarney Court Riveria Road Killarney Johannesburg |
| 13. Intended place of burial | West Park Cemetery Johannesburg |
| 14. Causes of death | Cerebral Haemorrhage Hyperpiesis? Heart Failure |
| 15. Duration of disease or of last illness | One Day. |
| 16. Name of medical practitioner | Doctor W.H. Palmer. |
| 17. Original signature (or mark) | ? ???? |
| 18. Qualification | Person Causing Burial |
| 19. Residence | 86 Wanderers Street Johannesburg |
FamilySearch South Africa, Civil registration (marriages, deaths), Transvaal, 1869-1954