Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Henry Gordon Goucher death at Middleton, Annapolis County on August 8, 1970
Male Death Registration: Year: 1970 number: 5039
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005039
1. PLACE OF DEATH County of Annapolis If in City or Town Middleton
If death occured in a hospital or institution Soldiers Memorial Hospital
3. PRINT NAME OF DECEASED Goucher, Henry Gordon
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 12 14, 1970
10. AGE in Years68 Months7 Days24 | hrs or mins
11. Trade or profession Insurance Broker
12. Kind of industry
13. Date last worked August 1, 1970 14. Total years Life
15. If married name of spouse Evelyn Bentley
16. NAME of Father Obed F. Goucher
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Ardelice Keyeah Dodge
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Evelyn Goucher
address 378 Main St., Middleton
Relationship to deceased Wife
21. Place of burial Pine Grove, Middleton
Date of burial August 11, 1970
22. Undertaker Warren T. Roop, Ltd., Middleton
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH August 8, 1970
CAUSE OF DEATH
(a) Carcinoma of Lung
(b)
(c)
other
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