Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Robin Frederick Everett death at Upper Port La Tour, Shelburne County on January 3, 1970
Male Death Registration: Year: 1970 number: 1288
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001288
1. PLACE OF DEATH County of Shelburne If in City or Town Upper Port La Tour
If death occured in a hospital or institution Upper Port Latour
3. PRINT NAME OF DECEASED Everett, Robin Frederick
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Manitoba
9. DATE OF BIRTH 7 26, 1954
10. AGE in Years15 Months5 Days8 | hrs or mins
11. Trade or profession Student
12. Kind of industry Attending School
13. Date last worked December 19, 1969 14. Total years 10
15. If married name of spouse
16. NAME of Father Francis Everett
17. BIRTHPLACE Manitoba
18. NAME of Mother Aleta Desrochers
19. BIRTHPLACE Manitoba
20. Signature of Informant Francis Everett per J.A.K
address Port Clyde, Sherlburne County
Relationship to deceased Father
21. Place of burial Shelburne
Date of burial January 7, 1970
22. Undertaker Kenney Funeral Service
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 3, 1970
CAUSE OF DEATH
(a) Perforation (R) Auricle of Aorta
(b) Gunshot Wound
(c)
other Rifle Accidentally fired at close range
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