Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Johnina Wales Roberts death at Yarmouth, Yarmouth County on April 30, 1970
Female Death Registration: Year: 1970 number: 3550
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003550
1. PLACE OF DEATH County of Yarmouth If in City or Town Yarmouth
If death occured in a hospital or institution Yarmouth Hospital
3. PRINT NAME OF DECEASED Roberts, Johnina Wales
4. Sex
Female
5. Citizenship
American
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE England
9. DATE OF BIRTH 11 6, 1889
10. AGE in Years80 Months5 Days24 | hrs or mins
11. Trade or profession Practical Nurse
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Thomas Forster
17. BIRTHPLACE England
18. NAME of Mother Mary Ann Wales
19. BIRTHPLACE England
20. Signature of Informant Harriet E Roberts
address 22908 Allen Court, St Clair Shores, Detroit, Michigan
Relationship to deceased Daughter
21. Place of burial Darling Lake, Yar. Co
Date of burial May 3, 1970
22. Undertaker Sweeny's Funeral Home, Yarmouth
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH April 30, 1970
CAUSE OF DEATH
(a) Cardiac Arrest
(b) Ruptured Aortic Aneurysm
(c)
other
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