Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Charles Sampson death at Halifax, Halifax County on January 2, 1970
Male Death Registration: Year: 1970 number: 1086
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001086
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Halifax Infirmary
3. PRINT NAME OF DECEASED Sampson, Charles
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Rockdale
9. DATE OF BIRTH 9 23, 1900
10. AGE in Years69 Months3 Days10 | hrs or mins
11. Trade or profession Cable Splicer
12. Kind of industry Dept. of Transport
13. Date last worked Jan. 1959 14. Total years 39 years
15. If married name of spouse Mrs. Alice Sampson
16. NAME of Father Charles Sampson
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Sophie Peters
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Alice Sampson
address 42 Elmwood Ave. Dartmouth
Relationship to deceased Wife
21. Place of burial St. Pauls Cemetery, Dartmouth
Date of burial Jan. 5 1970
22. Undertaker Dartmouth Funeral Home
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 2, 1970
CAUSE OF DEATH
(a) Carcinoma
(b) Bowel with multiple metastes
(c)
other
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