Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Matilda Samuels death at Windsor, Hants County on June 11, 1970
Female Death Registration: Year: 1970 number: 3869
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 003869
1. PLACE OF DEATH County of Hants If in City or Town Windsor
If death occured in a hospital or institution Payzant Memorial Hospital, Windsor
3. PRINT NAME OF DECEASED Samuels, Matilda
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Scottish
7. Single, Married
widowed
8. BIRTHPLACE Northeast Margaree
9. DATE OF BIRTH 11 7, 1893
10. AGE in Years76 Months7 Days4 | 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 Peter MacDonald
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Mary MacLeod
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Payzant Memorial Hospital Records
address Windsor
Relationship to deceased Nil
21. Place of burial Windsor
Date of burial June 13, 1970
22. Undertaker Lohnes Funeral Service Ltd., Windsor
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 11, 1970
CAUSE OF DEATH
(a) Gastric Hemorrhage
(b) Gastric Ulcer
(c)
other Arteriosclerosis
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