England, death certificate (certified copy) for Ann Perkes died 4 June 1856; registered 5 June 1856. Stourbridge district, Kingswinford Sub-district, County of Stafford; General Register Office, Southport.

Text from source:

CERTIFIED COPY OF AN ENTRY OF DEATH GIVEN AT THE GENERAL REGISTER OFFICE
Registration district Stourbridge
1856 Death in the sub-district of Kingswinford in the County of Stafford
No. When and where died Name and Surname Sex Age Occupation Cause of death Signature, description and residence of informant When registered Signature of registrar
218 4 Jun 1856 Delph Kingswinford Ann Perks Female 76 Widow of Thomas Perks coal miner Diarrhoea Old Age Certified X The mark of Caroline Perkes Present at the death Delph Kingswinford 5 Jun 1856