Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Mary Lavinia Boutilier death at Liverpool, Queens County on July 20, 1970
Female Death Registration: Year: 1970 number: 4598
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004598
1. PLACE OF DEATH County of Queens If in City or Town Liverpool
If death occured in a hospital or institution Fahies Nursing Home
3. PRINT NAME OF DECEASED Boutilier, Mary Lavinia
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Eagle Head
9. DATE OF BIRTH 10 1, 1869
10. AGE in Years100 Months9 Days19 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Housewife
13. Date last worked 1945 14. Total years
15. If married name of spouse Samuel Boutilier
16. NAME of Father William Wagner
17. BIRTHPLACE Nova Scotia
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Mrs. Maxwell Wharton
address 108 Church St. Liverpool
Relationship to deceased Cousin
21. Place of burial Eagle Head
Date of burial July 23, 1970
22. Undertaker Chandlers Funeral Home, Liverpool
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 20, 1970
CAUSE OF DEATH
(a) Generalized arterciosclersions
(b) Left ventracular failure
(c)
other
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