Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Chipman Morse Potter death at Digby, Digby County on September 29, 1970
Male Death Registration: Year: 1970 number: 5770
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 005770
1. PLACE OF DEATH County of Digby If in City or Town Digby
If death occured in a hospital or institution Digby General Hospital
3. PRINT NAME OF DECEASED Potter, Chipman Morse
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Clementsvale
9. DATE OF BIRTH 7 9, 1890
10. AGE in Years80 Months2 Days20 | hrs or mins
11. Trade or profession Farmer
12. Kind of industry
13. Date last worked 10 years 14. Total years 50 years
15. If married name of spouse Kathryn C Potter
16. NAME of Father Benjamin Eber Potter
17. BIRTHPLACE Clementsvale, Annapolis Co
18. NAME of Mother Elizabeth Ann Morse
19. BIRTHPLACE Tremont
20. Signature of Informant Mrs Kathryn C Potter
address Clementsvale, Annapolis Co.
Relationship to deceased wife
21. Place of burial Clementsvale
Date of burial Obtober 1, 1970
22. Undertaker Chisholm's Funeral Home, Granville Ferry
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 29, 1970
CAUSE OF DEATH
(a) Cerebral Thrombosis
(b) Arteriosclerosis
(c)
other
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