Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Ada Rebeca Cleveland death at Dayspring, Lunenburg County on July 23, 1970
Female Death Registration: Year: 1970 number: 4968
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004968
1. PLACE OF DEATH County of Lunenburg If in City or Town Dayspring
If death occured in a hospital or institution Municipal Home
3. PRINT NAME OF DECEASED Cleveland, Ada Rebeca
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 8 17, 1882
10. AGE in Years87 Months11 Days6 | hrs or mins
11. Trade or profession Housewife
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse David Cleveland
16. NAME of Father James Burgoyne
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Annie Rhuder
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Harold L. Cleveland
address Blandford
Relationship to deceased
21. Place of burial Blandford
Date of burial July 25, 1970
22. Undertaker Davis Funeral Home, Chester
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 23, 1970
CAUSE OF DEATH
(a) Congestive Heart failure
(b) cancer of bowel
(c)
other
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