| Sex | Female |
| Age | 62 |
| |
| Born | 28 July 1866 | in | Utrecht UT (NL) |
| Registration | 31 July 1866 |
|
| Died | 25 September 1928 | in | Eindhoven NB (NL) |
| at | 04:30 | |
| Registration | 25 September 1928 |
| Witness(es) | Theodorus Johannes Hillege (nurse)
Cornelis Johannes van der Horst (doorkeeper) |
|
| Father | Didericus van Blaricum |
| | Born | 2 March 1824 |
| | Died | 12 December 1888 |
| Mother | Cornelia Voets |
| | Born | about 1827 |
| | Died | 25 March 1889 |
| Sister | Hendrika Maria Catharina Wilhelmina born 24 September 1850 |
| Sister | Elisabeth Cornelia born 23 October 1851 |
| Brother | Didericus Josephus born 27 October 1852 |
| Brother | Hendrikus Adrianus born 2 April 1855 |
| Sister | Elisabeth Maria born 7 August 1857 |
| Sister | Cornelia Adriana born 10 March 1861 |
| Brother | Wilhelmus born 21 May 1864 |
|
