Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Raymond Samson death at Sydney River, Cape Breton County on January 24, 1970
Male Death Registration: Year: 1970 number: 1463
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001463
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney River
If death occured in a hospital or institution C. B. County Hosp.
3. PRINT NAME OF DECEASED Samson, Raymond
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French/White
7. Single, Married
widowed
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 8 21, 1893
10. AGE in Years76 Months5 Days4 | hrs or mins
11. Trade or profession Merchant
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Alain Samson
17. BIRTHPLACE Petit de Grat
18. NAME of Mother Marjorie Boudreau
19. BIRTHPLACE Petit de Grat
20. Signature of Informant Mrs. Peter Samson
address Petit De Grat
Relationship to deceased Daughter
21. Place of burial Petit de Grat
Date of burial January 27, 1970
22. Undertaker CH Boudreau Funeral Home Arichat
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 24, 1970
CAUSE OF DEATH
(a) Cardiac Failure
(b) Cardiac Disease
(c) Chronic brain syndrome
other
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