Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Arthur Sampson death at Halifax, Halifax County on September 23, 1970
Male Death Registration: Year: 1970 number: 5700
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005700
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Victoria General Hospital
3. PRINT NAME OF DECEASED Sampson, Arthur
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
African
7. Single, Married
married
8. BIRTHPLACE Halifax
9. DATE OF BIRTH 2 4, 1926
10. AGE in Years44 Months7 Days19 | hrs or mins
11. Trade or profession Cook
12. Kind of industry Naval Research
13. Date last worked June 1969 14. Total years 11
15. If married name of spouse Bernice Sampson
16. NAME of Father Daniel Sampson
17. BIRTHPLACE West Indies
18. NAME of Mother Rita Medley
19. BIRTHPLACE Halifax
20. Signature of Informant Bernice Sampson
address 5671 Cunard St. Halifax
Relationship to deceased Wife
21. Place of burial Hillcrest Memorial Gardens, Lower Sackville
Date of burial September 25, 1970
22. Undertaker Cruikshanks Funeral Home Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 23, 1970
CAUSE OF DEATH
(a) Bilateral Pneumonia
(b)
(c)
other
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