Male Death Registration: Year: 1970 number: 6809
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 006809
1. PLACE OF DEATH County of Cape Breton If in City or Town Glace Bay
If death occured in a hospital or institution St. Joseph's Hospital
3. PRINT NAME OF DECEASED Koziel, Victor
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
Polish
7. Single, Married
married
8. BIRTHPLACE Poland
9. DATE OF BIRTH 7 18, 1903
10. AGE in Years67 Months2 Days8 | hrs or mins
11. Trade or profession Confectionary store
12. Kind of industry Self-employed
13. Date last worked 1958 14. Total years 20
15. If married name of spouse Cecilia Tavgrub
16. NAME of Father Albert Koziel
17. BIRTHPLACE Poland
18. NAME of Mother Maria
19. BIRTHPLACE Poland
20. Signature of Informant Victor Koziel Jr
address 123 Wallace Road, Glace Bay
Relationship to deceased Son
21. Place of burial St. John's Cemetery, Glace Bay
Date of burial Sept 30, 1970
22. Undertaker Curry's Funeral Home, Glace Bay
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH September 26, 1970
CAUSE OF DEATH
(a) Pulmonary emphysema
(b)
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/
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