Male Death Registration: Year: 1970 number: 4990
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004990
1. PLACE OF DEATH County of Shelburne If in City or Town Gunning Cove
3. PRINT NAME OF DECEASED Potter, Carlos L
4. Sex
Male
5. Citizenship
American
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Boston, Massachusetts, USA
9. DATE OF BIRTH 3 14, 1903
10. AGE in Years67 Months5 Days2 | hrs or mins
11. Trade or profession Wireless Operator
12. Kind of industry
13. Date last worked 1967 14. Total years 40
15. If married name of spouse
16. NAME of Father Walter L Potter
17. BIRTHPLACE Boston
18. NAME of Mother Florence Doone
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Maretta Potter
address 50 Haskell St., N. Cambridge, Mass
Relationship to deceased Sister
21. Place of burial Carleton Village
Date of burial Aug 19, 1970
22. Undertaker H M Huskilson, Shelburne
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 16, 1970
CAUSE OF DEATH
(a) Coronary Thrombosis
(b)
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=490299
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