Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Henry Clarence Kloosterhof death at Stewiacke, Colchester County on May 17, 1970
Male Death Registration: Year: 1970 number: 3370
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003370
1. PLACE OF DEATH County of Colchester If in City or Town Stewiacke
3. PRINT NAME OF DECEASED Kloosterhof, Henry Clarence
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Dutch
7. Single, Married
single
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 1 29, 1968
10. AGE in Years2 Months3 Days18 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Clarence Kloosterhof
17. BIRTHPLACE Holland
18. NAME of Mother Johanna W G Klikkema
19. BIRTHPLACE Holland
20. Signature of Informant Mrs Clarence Kloosterhof
address Stewiacke
Relationship to deceased Mother
21. Place of burial Stewiacke East
Date of burial 2 pm, May 20, 1970
22. Undertaker Ettinger Funeral Service Ltd
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH May 17, 1970
CAUSE OF DEATH
(a) skull fracture(s)
(b)
(c)
other Accident
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