Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Harvey Everette Jackson death at Halifax, Halifax County on June 1, 1970
Male Death Registration: Year: 1970 number: 3588
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003588
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Camp Hill Hospital
3. PRINT NAME OF DECEASED Jackson, Harvey Everette
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
separated
8. BIRTHPLACE Ontario
9. DATE OF BIRTH 4 11, 1899
10. AGE in Years71 Months1 Days21 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 1964 14. Total years
15. If married name of spouse
16. NAME of Father
17. BIRTHPLACE
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant William Patterson
address Camphill Hospital Records
Relationship to deceased None
21. Place of burial Parham, Ontario
Date of burial June 2, 1970
22. Undertaker Cruikshank Funeral Home Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 1, 1970
CAUSE OF DEATH
(a) Bronchopneumonia
(b) Cor Pulmonale
(c) Emphysema
other
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