Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Bertram Simon Sampson death at West L'Ardoise, Richmond County on October 20, 1970
Male Death Registration: Year: 1970 number: 6365
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006365
1. PLACE OF DEATH County of Richmond If in City or Town West L'Ardoise
3. PRINT NAME OF DECEASED Sampson, Bertram Simon
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
French
7. Single, Married
married
8. BIRTHPLACE Halifax
9. DATE OF BIRTH 12 29, 1909
10. AGE in Years60 Months9 Days21 | hrs or mins
11. Trade or profession Retired Nurse
12. Kind of industry Camp Hill Hospital
13. Date last worked 1958 14. Total years 14
15. If married name of spouse Mary C. Sampson
16. NAME of Father Charles Sampson
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Alexina Boudreau
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Bertram Sampson
address West L'Ardoise C.B.
Relationship to deceased Wife
21. Place of burial Gate of Heaven
Date of burial Oct. 23rd 1970
22. Undertaker Halifax Funeral Home Ltd.
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH October 20, 1970
CAUSE OF DEATH
(a) Coronary occlusion
(b) arteriosclerosis
(c)
other
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