Male Death Registration: Year: 1971 number: 1279
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 001279
1. PLACE OF DEATH County of Queens If in City or Town South Brookfield
If death occured in a hospital or institution Highway (at home), South Brookfield
3. PRINT NAME OF DECEASED Smith, Thelston Parke
4. Sex
Male
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
divorced
8. BIRTHPLACE Port Medway, Queens County
9. DATE OF BIRTH 2 19, 1922
10. AGE in Years48 Months10 Days26 | hrs or mins
11. Trade or profession Retired
12. Kind of industry Grocery Store Manager
13. Date last worked August 21, 1970 14. Total years
15. If married name of spouse
16. NAME of Father Parke Smith
17. BIRTHPLACE Nova Scotia
18. NAME of Mother Elaine Fisk Daley
19. BIRTHPLACE Nova Scotia
20. Signature of Informant Mrs. Raymond Savage
address 436 Spring St., R.F.D. Whitman, Mass.
Relationship to deceased Sister
21. Place of burial North Brookfield
Date of burial January 17, 1971
22. Undertaker Chandler's Funeral Home, Liverpool
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH January 14, 1971
CAUSE OF DEATH
(a) Manic Depression
(b)
(c)
other
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=493357
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