Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Lottie Crooks death at Antigonish, Antigonish County on January 1, 1971
Female Death Registration: Year: 1971 number: 1005
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001005
1. PLACE OF DEATH County of Antigonish If in City or Town Antigonish
If death occured in a hospital or institution St. Martha's Hospital
3. PRINT NAME OF DECEASED Crooks, Lottie
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
Irish
7. Single, Married
widowed
8. BIRTHPLACE Drum Head
9. DATE OF BIRTH 9 30, 1891
10. AGE in Years79 Months3 Days2 | 11 hrs or 30 mins
11. Trade or profession House Wife
12. Kind of industry
13. Date last worked Dec./1970 14. Total years 56
15. If married name of spouse George Crooks (dec.)
16. NAME of Father James Edward Burke
17. BIRTHPLACE Drum Head
18. NAME of Mother Orena Langley
19. BIRTHPLACE Seal Harbour
20. Signature of Informant Donald D. Crooks
address Drum Head, Guys. Co.
Relationship to deceased Son
21. Place of burial Seal Harbour
Date of burial January 3, 1971
22. Undertaker Parker Giffin, Goldboro
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 1, 1971
CAUSE OF DEATH
(a) uremic coma
(b) arteriosclerosis
(c) chronic glomerulonephritis
other chronic congestive cardiac failure
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