Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Andrew David Clark death at North Sydney, Cape Breton County on June 28, 1970
Male Death Registration: Year: 1970 number: 4150
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004150
1. PLACE OF DEATH County of Cape Breton If in City or Town North Sydney
If death occured in a hospital or institution St Elizabeth Hospital
3. PRINT NAME OF DECEASED Clark, Andrew David
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 12 6, 1887
10. AGE in Years82 Months6 Days22 | hrs or mins
11. Trade or profession Labourer
12. Kind of industry Town of North Sydney
13. Date last worked 1955 14. Total years 50
15. If married name of spouse Maude Clark
16. NAME of Father William Henry Clark
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Catherine Harris
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Andrew D Clark (Jr)
address 45 Brook St, North Sydney
Relationship to deceased Son
21. Place of burial Lakeside, North Sydney
Date of burial June 30 1970
22. Undertaker W J Dooley Funeral Service Ltd, North Sydney
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH June 28, 1970
CAUSE OF DEATH
(a) Acute Heart Failure
(b) Acute myocarditis
(c)
other
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