Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Clifford Roy Decker death at Lake John, Shelburne County on April 28, 1970
Male Death Registration: Year: 1970 number: 3196
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003196
1. PLACE OF DEATH County of Shelburne If in City or Town Lake John
3. PRINT NAME OF DECEASED Decker, Clifford Roy
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
divorced
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 8 12, 1929
10. AGE in Years40 Months8 Days16 | hrs or mins
11. Trade or profession Fisherman
12. Kind of industry
13. Date last worked 1969 14. Total years 10 years
15. If married name of spouse
16. NAME of Father William Decker
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Stacie MacKenzie
19. BIRTHPLACE Nova Scotia
20. Signature of Informant William St Clair Decker
address Lockeport
Relationship to deceased Brother
21. Place of burial Jordan Falls
Date of burial 1 May 1970
22. Undertaker H M Huskilson's Funeral Home, Shelburne
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH April 28, 1970
CAUSE OF DEATH
(a)
(b)
(c)
other
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