Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Catherine Mary Sample death at Stellarton, Pictou County on July 20, 1970
Female Death Registration: Year: 1970 number: 5296
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005296
1. PLACE OF DEATH County of Pictou If in City or Town Stellarton
3. PRINT NAME OF DECEASED Sample, Catherine Mary
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Scottish
7. Single, Married
widowed
8. BIRTHPLACE Bridgeville
9. DATE OF BIRTH 5 14, 1900
10. AGE in Years70 Months2 Days6 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Robert Sample
16. NAME of Father Daniel MacEachern
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Elizabeth Hollis
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Robert Sample
address Stellarton
Relationship to deceased Son
21. Place of burial Brookside Cemetery, Stellarton
Date of burial 20 July 1970
22. Undertaker MacQuarrie, Stellarton
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 20, 1970
CAUSE OF DEATH
(a)
(b)
(c)
other
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