Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Rozelia Harriet Crouse death at Caledonia, Queens County on January 6, 1971
Female Death Registration: Year: 1971 number: 1043
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001043
1. PLACE OF DEATH County of Queens If in City or Town Caledonia
If death occured in a hospital or institution North Queens Nursing Home Inc.
3. PRINT NAME OF DECEASED Crouse, Rozelia Harriet
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
widowed
8. BIRTHPLACE Nova Scotia
9. DATE OF BIRTH 6 2, 1890
10. AGE in Years80 Months7 Days4 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Housewife
13. Date last worked 14. Total years
15. If married name of spouse Charles Crouse
16. NAME of Father Stephen Conrad
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Elizabeth Faulkenham
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mr. Landis Crouse
address West Berlin, Queens Co.
Relationship to deceased Nephew
21. Place of burial West Berlin, Queens Co.
Date of burial January 8, 1971
22. Undertaker Chandler's Funeral Home, Liverpool
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 6, 1971
CAUSE OF DEATH
(a) Pulmonary ocdema
(b) myocardial degeneration
(c) Diabetes Mellitus
other Organic Brain Syndrome Pernicious Anaemia
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