Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Kimberly Burgess death at Liverpool, Queens County on September 24, 1970
Female Death Registration: Year: 1970 number: 5683
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005683
1. PLACE OF DEATH County of Queens If in City or Town Liverpool
If death occured in a hospital or institution Queen's General Hospital.
3. PRINT NAME OF DECEASED Burgess, Kimberly
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Liverpool
9. DATE OF BIRTH 9 22, 1970
10. AGE in Years Months Days2 | hrs or mins
11. Trade or profession Infant.
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Milton Burgess
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Syvilla Roy
19. BIRTHPLACE Nova Scotia
20. Signature of Informant
address RR#1 Port Mouton
Relationship to deceased Aunt.
21. Place of burial South West Port Mouton
Date of burial September 26, 1970
22. Undertaker Chandler's Funeral Service Ltd. Liverpool
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 24, 1970
CAUSE OF DEATH
(a) Sudden Unexpected Death
(b)
(c)
other
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