Nova Scotia Archives
Nova Scotia Births, Marriages, and Deaths
William Patrick Sampson death at Halifax, Halifax County on January 16, 1971
Male Death Registration: Year: 1971 number: 1193
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001193
1. PLACE OF DEATH County of Halifax If in City or Town Halifax
If death occured in a hospital or institution Hfx. Infirmary
3. PRINT NAME OF DECEASED Sampson, William Patrick
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Halifax
9. DATE OF BIRTH 6 29, 1903
10. AGE in Years67 Months6 Days18 | hrs or mins
11. Trade or profession N.S. Light and Power
12. Kind of industry
13. Date last worked 1969 14. Total years
15. If married name of spouse Virginia Sampson
16. NAME of Father William Sampson
17. BIRTHPLACE Nova Scotia
18. NAME of Mother
19. BIRTHPLACE
20. Signature of Informant Owen MacDonald
address 6694 Chisholm Ave., Hfx.
Relationship to deceased Son-in-Law
21. Place of burial Gate of Heaven, Lr. Sack.
Date of burial January 18, 1971
22. Undertaker R.D. Lindsay, Halifax
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 16, 1971
CAUSE OF DEATH
(a) Congestive Heart & Renal Failure
(b) Myocardial Infarction
(c)
other
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