Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
Clarence William Clarke death at Halifax, Halifax County on January 15, 1971
Male Death Registration: Year: 1971 number: 1189
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001189
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution I W K Childrens Hospital
3. PRINT NAME OF DECEASED Clarke, Clarence William
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
single
8. BIRTHPLACE Halifax
9. DATE OF BIRTH 8 6, 1969
10. AGE in Years1 Months5 Days9 | hrs or mins
11. Trade or profession
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse
16. NAME of Father Donald Roy Clarke
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Betty Jean Rankin
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Betty J Clarke
address Enfield Hants Co. Nova Scotia
Relationship to deceased Mother
21. Place of burial Elmsdale, Nova Scotia
Date of burial January 18, 1971
22. Undertaker Withrow MacMillan
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 15, 1971
CAUSE OF DEATH
(a) Septicemia
(b) Disseminated Herpes Moniliasis
(c)
other
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