Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Alfred Sampson death at Halifax, Halifax County on June 11, 1970
Male Death Registration: Year: 1970 number: 3804
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003804
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution at home
3. PRINT NAME OF DECEASED Sampson, Alfred
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Lordways
9. DATE OF BIRTH 2 5, 1919
10. AGE in Years51 Months4 Days6 | hrs or mins
11. Trade or profession Civil Servant
12. Kind of industry Stadacona
13. Date last worked 14. Total years 17
15. If married name of spouse Evelyn Green
16. NAME of Father Thomas Sampson
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Victoria Ranson
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Evelyn Sampson
address 6641 Chisholm Avenue, Halifax
Relationship to deceased Wife
21. Place of burial Gate of Heaven, Lr Sackville
Date of burial June 13, 1970
22. Undertaker R D Lindsay Funeral Home, Halifax
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 11, 1970
CAUSE OF DEATH
(a) Pulmonary Embolism
(b) Fracture of L tibia & fibula
(c)
other Fell from platform
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